MEDICARE: RACHEL MIRIAM NIKNAM MD

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	207WX0009X	Glaucoma Specialist (Ophthalmology) Physician	MD428282	PA
2	207W00000X	Ophthalmology Physician	MD428282	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	:	1649215245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL MIRIAM NIKNAM MD

Provider Business Mailing Address
First Line	:	601 WALNUT ST STE 210W
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-3323
Country	:	US
Telephone Number	:	215-925-6402
Fax Number	:	215-925-0262

Provider Business Practice Location Address
First Line	:	601 WALNUT ST STE 210W
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-3323
Country	:	US
Telephone Number	:	215-925-6402
Fax Number	:	215-925-0262

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

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	09/02/2020

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Directions to “ RACHEL MIRIAM NIKNAM MD” Practice Location

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