Provider Demographics
NPI:1689812406
Name:CHIOTA-MCCOLLUM, NICOLE A (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:CHIOTA-MCCOLLUM
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 1:555 NORTH DUKE STREET
Mailing Address - Street 2:NEUROSCIENCE SERVICE LINE ADMINISTRATION
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-3555
Mailing Address - Country:US
Mailing Address - Phone:717-544-5008
Mailing Address - Fax:717-544-5041
Practice Address - Street 1:555 NORTH DUKE STREET
Practice Address - Street 2:NEUROSCIENCE SERVICE LINE ADMINISTRATION
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-3555
Practice Address - Country:US
Practice Address - Phone:717-544-5008
Practice Address - Fax:717-544-5041
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD4748802084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program