Provider Demographics
NPI:1083705743
Name:SZUMSKI, NICHOLAS R (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:R
Last Name:SZUMSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N ROBERTSON BLVD
Mailing Address - Street 2:SUITE 518
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1788
Mailing Address - Country:US
Mailing Address - Phone:310-385-6016
Mailing Address - Fax:310-385-6080
Practice Address - Street 1:250 N ROBERTSON BLVD
Practice Address - Street 2:SUITE 518
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1788
Practice Address - Country:US
Practice Address - Phone:310-385-6016
Practice Address - Fax:310-385-6080
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA868072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A86807Medicaid
CA00A86807Medicaid