Provider Demographics
NPI:1083686893
Name:NICKOWITZ, RICHARD EMERY (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EMERY
Last Name:NICKOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:50 ALESSANDRO PLACE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3149
Mailing Address - Country:US
Mailing Address - Phone:626-793-7114
Mailing Address - Fax:626-793-7679
Practice Address - Street 1:50 ALESSANDRO PL
Practice Address - Street 2:SUITE 410
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3149
Practice Address - Country:US
Practice Address - Phone:626-793-7114
Practice Address - Fax:626-793-7679
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG075648207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF58523Medicare UPIN