Provider Demographics
NPI:1710005335
Name:NICOTERO, JAMES ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ANTHONY
Last Name:NICOTERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 LOWRY AVE
Mailing Address - Street 2:BUILDINGS A-B
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-3071
Mailing Address - Country:US
Mailing Address - Phone:724-527-2845
Mailing Address - Fax:724-527-6490
Practice Address - Street 1:1113 LOWRY AVE
Practice Address - Street 2:BUILDINGS A-B
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-3071
Practice Address - Country:US
Practice Address - Phone:724-527-2845
Practice Address - Fax:724-527-6490
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA028757L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4031281Medicare ID - Type Unspecified