Provider Demographics
NPI:1295861946
Name:MARIA D. NIKOLAIDIS, M.D., P.A.
Entity Type:Organization
Organization Name:MARIA D. NIKOLAIDIS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:NIKOLAIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-354-5663
Mailing Address - Street 1:24375 FM 1314 RD
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-4205
Mailing Address - Country:US
Mailing Address - Phone:281-354-5663
Mailing Address - Fax:281-354-1995
Practice Address - Street 1:24375 FM 1314 RD
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-4205
Practice Address - Country:US
Practice Address - Phone:281-354-5663
Practice Address - Fax:281-354-1995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4032208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty