MEDICARE: NICOS NICOLAOU 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	2085R0001X	Radiation Oncology Physician	MD053676L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619998085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOS NICOLAOU M.D.

Provider Business Mailing Address
First Line	:	1 PRESIDENTIAL BLVD
Second Line	:	SUITE 100
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-1017
Country	:	US
Telephone Number	:	610-632-4100
Fax Number	:	610-668-1004

Provider Business Practice Location Address
First Line	:	1 PRESIDENTIAL BLVD
Second Line	:	SUITE 100
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-1017
Country	:	US
Telephone Number	:	610-632-4100
Fax Number	:	610-668-1004

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	10/03/2012

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Directions to “ NICOS NICOLAOU M.D.” Practice Location

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