Provider Demographics
NPI:1588627731
Name:MARO, NICHOLAS P (DPM)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:P
Last Name:MARO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 WHEELER AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1471
Mailing Address - Country:US
Mailing Address - Phone:570-839-7005
Mailing Address - Fax:570-839-7004
Practice Address - Street 1:1001 WHEELER AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1471
Practice Address - Country:US
Practice Address - Phone:570-839-7005
Practice Address - Fax:570-839-7004
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003263L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1089210003Medicare NSC
PA602152Medicare ID - Type Unspecified
PAT92715Medicare UPIN
PA1089210002Medicare NSC