Provider Demographics
NPI:1154464220
Name:CARRICATO, NICHOLAS DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:DEAN
Last Name:CARRICATO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 780982
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0982
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:200 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1831
Practice Address - Country:US
Practice Address - Phone:502-629-8000
Practice Address - Fax:303-306-7753
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41860207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200918710OtherMEDICAID - IN - WS
KYP00869561OtherRAILROAD MEDICARE - KY
KY000000583717OtherANTHEM - WS
KY00533058OtherMEDICARE - CMA
KY50021447OtherPASSPORT - WS
KY099159OtherSIHO - WS
KY7100061820OtherMEDICAID - W SP
KS3552751000OtherPASSPORT ADVTG - WS
KS3552751000OtherPASSPORT ADVTG - WS
IN200918710OtherMEDICAID - IN - WS