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General NPI Number Information
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NPI Number | 1376569715
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Entity Type | Individual
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Provider Name | DEBORAH NILES MD FAAFP
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Gender | Female
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 01/11/2023
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Provider Practice Location Address
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Address Line | 1575 N 52ND ST STE S-3
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City | PHILADELPHIA
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State | PA
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Zip | 19131-4736
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Country | US
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Telephone | 267-930-4858
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Fax | 267-299-6270
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Provider Business Mailing Address
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Address Line | 1575 N 52ND ST STE S-3
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City | PHILADELPHIA
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State | PA
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Zip | 19131-4736
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Country | US
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Telephone | 267-930-4858
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Fax | 267-299-6270
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MA06826500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD070917L
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License Number State | PA
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