MEDICARE: DR. NINO OQROSHIDZE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	HS000163L	PA
2	207Q00000X	Family Medicine Physician	MD452940	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HS000163L	OTHER	PA	LICENSE

General Provider Information

NPI Number	:	1255628897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NINO OQROSHIDZE M.D.

Provider Business Mailing Address
First Line	:	1820 BETHLEHEM PIKE
Second Line	:
City	:	FLOURTOWN
State	:	PA
Zip	:	19031-1504
Country	:	US
Telephone Number	:	215-836-1354
Fax Number	:	215-836-2605

Provider Business Practice Location Address
First Line	:	1820 BETHLEHEM PIKE
Second Line	:
City	:	FLOURTOWN
State	:	PA
Zip	:	19031-1504
Country	:	US
Telephone Number	:	215-836-1354
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2011
Last Update Date	:	03/17/2018

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