Provider Demographics
NPI:1659430965
Name:SIMONE, NICOLE L (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:L
Last Name:SIMONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S. 11TH STREET
Mailing Address - Street 2:BODINE CENTER FOR CANCER TREATMENT
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4824
Mailing Address - Country:US
Mailing Address - Phone:215-955-6702
Mailing Address - Fax:215-955-5331
Practice Address - Street 1:111 S. 11TH STREET
Practice Address - Street 2:BODINE CENTER FOR CANCER TREATMENT
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4824
Practice Address - Country:US
Practice Address - Phone:215-955-6702
Practice Address - Fax:215-955-5331
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD621432085R0001X
PAMD4416572085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0255327Medicaid
PA102558180 0001Medicaid
PA102558180 0001Medicaid