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General NPI Number Information
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NPI Number | 1154493534
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Entity Type | Organization
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Legal Business Name | EDWARD P. NIKICICZ, M.D., P.C.
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 12/15/2010
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Provider Practice Location Address
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Address Line | 200 MEDICAL PARK BLVD
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City | PETERSBURG
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State | VA
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Zip | 23805-9274
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Country | US
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Telephone | 804-765-5026
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Fax |
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Provider Business Mailing Address
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Address Line | 3908 MCTYRES COVE CT
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-4665
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDWARD PETER NIKICICZ
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Credential | M.D.
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Telephone | 804-862-5028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | VA0101047885
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License Number State | VA
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