Provider Demographics
NPI:1376569715
Name:NILES, DEBORAH (MD FAAFP)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:NILES
Suffix:
Gender:F
Credentials:MD FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 N 52ND ST STE S-3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-4736
Mailing Address - Country:US
Mailing Address - Phone:267-930-4858
Mailing Address - Fax:267-299-6270
Practice Address - Street 1:1575 N 52ND ST STE S-3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-4736
Practice Address - Country:US
Practice Address - Phone:267-930-4858
Practice Address - Fax:267-299-6270
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06826500207Q00000X
PAMD070917L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H13415Medicare UPIN