MEDICARE: NICKOLAS THEOPHILOS AGATHIS M.D. (IN MAY 2015)

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	208000000X	Pediatrics Physician	87978	GA

General Provider Information

NPI Number	:	1740676535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICKOLAS THEOPHILOS AGATHIS M.D. (IN MAY 2015)

Provider Business Mailing Address
First Line	:	10364 COLLEGE SQ
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-4659
Country	:	US
Telephone Number	:	908-739-7500
Fax Number	:

Provider Business Practice Location Address
First Line	:	8901 WISCONSIN AVE
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20889-2724
Country	:	US
Telephone Number	:	301-400-0408
Fax Number	:

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

Provider Enumeration Date	:	04/08/2015
Last Update Date	:	08/15/2024

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