Provider Demographics
NPI:1518140946
Name:KARIS, NICHOLAS JOHN (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JOHN
Last Name:KARIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:J
Other - Last Name:KARIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2435 W BELVEDERE AVE STE 42
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5224
Mailing Address - Country:US
Mailing Address - Phone:410-601-6491
Mailing Address - Fax:410-601-5835
Practice Address - Street 1:2435 W BELVEDERE AVE STE 42
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5224
Practice Address - Country:US
Practice Address - Phone:410-601-6491
Practice Address - Fax:410-601-5835
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104895208G00000X
IN01065438A208G00000X
NY261058208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200913030CMedicaid
IN200913030DMedicaid
NY03351631Medicaid
IN200913030AMedicaid
IL036104895Medicaid
IN200913030BMedicaid
IN200913030EMedicaid
IN200913030AMedicaid
IN200913030BMedicaid
ILR02372Medicare PIN
IL036104895Medicaid
IN408430AAMedicare PIN