Provider Demographics
NPI:1184683369
Name:NIKAS, MARIANNE R (MD)
Entity Type:Individual
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First Name:MARIANNE
Middle Name:R
Last Name:NIKAS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:412 CREAMERY WAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2500
Mailing Address - Country:US
Mailing Address - Phone:610-594-7590
Mailing Address - Fax:610-594-2625
Practice Address - Street 1:217 REECEVILLE RD
Practice Address - Street 2:SUITE A
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-1572
Practice Address - Country:US
Practice Address - Phone:610-269-9448
Practice Address - Fax:610-594-2625
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
PAMD070065L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001814784Medicaid
PA001814784Medicaid
PAH22824Medicare UPIN