Provider Demographics
NPI:1891003208
Name:ADEGBITE-MARAVENTANO, NICHELLE SECORRA (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHELLE
Middle Name:SECORRA
Last Name:ADEGBITE-MARAVENTANO
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Gender:F
Credentials:MD
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Mailing Address - Street 1:100 PENN SQUARE EAST - NORTH TOWER
Mailing Address - Street 2:WANAMAKER BLDG - 9TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9232
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:CHILDREN'S HOSPITAL OF PHILADELPHIA
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:215-590-1000
Practice Address - Fax:215-590-2180
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2013-08-21
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Provider Licenses
StateLicense IDTaxonomies
PAMD437835208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics