Provider Demographics
NPI:1497970107
Name:SKARIC, NICOLAS C (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:C
Last Name:SKARIC
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:2121 YGNACIO VALLEY RD
Mailing Address - Street 2:SUITE E204
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3383
Mailing Address - Country:US
Mailing Address - Phone:925-939-5866
Mailing Address - Fax:925-939-3416
Practice Address - Street 1:2121 YGNACIO VALLEY RD
Practice Address - Street 2:SUITE E204
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3383
Practice Address - Country:US
Practice Address - Phone:925-939-5866
Practice Address - Fax:925-939-3416
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA00A314350208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A314350Medicare ID - Type Unspecified
CAA26480Medicare UPIN