Provider Demographics
NPI:1730297003
Name:NIEMOLLER, ULRICH MARCUS (MD)
Entity Type:Individual
Prefix:DR
First Name:ULRICH
Middle Name:MARCUS
Last Name:NIEMOLLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:U
Other - Middle Name:MARCUS
Other - Last Name:NIEMOLLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1235 OLD YORK RD
Mailing Address - Street 2:SUITE G 10
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3800
Mailing Address - Country:US
Mailing Address - Phone:215-481-6161
Mailing Address - Fax:215-481-6162
Practice Address - Street 1:1235 OLD YORK RD
Practice Address - Street 2:SUITE G 10
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3800
Practice Address - Country:US
Practice Address - Phone:215-481-6161
Practice Address - Fax:215-481-6162
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063479L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000046Medicare PIN
PAG61652Medicare UPIN