Provider Demographics
NPI:1922068493
Name:NICKELS, MICHAEL S (MD, PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:NICKELS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 S QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-4637
Mailing Address - Country:US
Mailing Address - Phone:717-843-6663
Mailing Address - Fax:717-852-0670
Practice Address - Street 1:1620 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4637
Practice Address - Country:US
Practice Address - Phone:717-843-6663
Practice Address - Fax:717-852-0670
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424414207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA091043Medicare ID - Type UnspecifiedPROVIDER NUMBER
PA091045T85Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
PAI 29882Medicare UPIN
PAT85Medicare PIN