Provider Demographics
NPI:1619094877
Name:MARAVICH, NICHOLAS MICHAEL (HAD)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:MICHAEL
Last Name:MARAVICH
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 BOWER HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1312
Mailing Address - Country:US
Mailing Address - Phone:412-276-0849
Mailing Address - Fax:
Practice Address - Street 1:3515 WASHINGTON ROAD
Practice Address - Street 2:
Practice Address - City:MCMURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-0856
Practice Address - Country:US
Practice Address - Phone:724-941-4037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2321237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist