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General NPI Number Information
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NPI Number | 1295861946
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Entity Type | Organization
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Legal Business Name | MARIA D. NIKOLAIDIS, M.D., P.A.
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 24375 FM 1314 RD
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City | PORTER
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State | TX
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Zip | 77365-4205
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Country | US
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Telephone | 281-354-5663
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Fax | 281-354-1995
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Provider Business Mailing Address
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Address Line | 24375 FM 1314 RD
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City | PORTER
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State | TX
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Zip | 77365-4205
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Country | US
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Telephone | 281-354-5663
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Fax | 281-354-1995
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Authorized Official
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Title or Position | SENIOR MEDICAL DIRECTOR
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Name | MARIA D. NIKOLAIDIS
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Credential | M.D.
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Telephone | 281-354-5663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | E4032
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License Number State | TX
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