Provider Demographics
NPI:1629401435
Name:NICHOLAS O BIASOTTO DO PA
Entity Type:Organization
Organization Name:NICHOLAS O BIASOTTO DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BIASOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-998-1284
Mailing Address - Street 1:620 STANTON CHRISTIANA RD
Mailing Address - Street 2:STE 205
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2133
Mailing Address - Country:US
Mailing Address - Phone:302-998-1284
Mailing Address - Fax:302-998-1267
Practice Address - Street 1:620 STANTON CHRISTIANA RD
Practice Address - Street 2:STE 205
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2133
Practice Address - Country:US
Practice Address - Phone:302-998-1284
Practice Address - Fax:302-998-1267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0002000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty