Provider Demographics
NPI:1093718819
Name:NICKOLOVA, MARIA K (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:K
Last Name:NICKOLOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:85 BRYANT WOODS S
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-3604
Mailing Address - Country:US
Mailing Address - Phone:716-689-3333
Mailing Address - Fax:716-689-9866
Practice Address - Street 1:85 BRYANT WOODS S
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-3604
Practice Address - Country:US
Practice Address - Phone:716-689-3333
Practice Address - Fax:716-689-9866
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1767582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000510644006OtherHEALTH INTEGRATED
NY1506150OtherINDEPENDENT HEALTH
NY11123758OtherCAQH
NY145074OtherVALUE OPTIONS
NY00010127103OtherUNIVERA
NY01136552Medicaid
NY01136552Medicaid
NYE35587Medicare UPIN