Provider Demographics
NPI:1205111820
Name:GARG, NICK SONU (MD)
Entity type:Individual
Prefix:DR
First Name:NICK
Middle Name:SONU
Last Name:GARG
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 1:133 S 36TH ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3246
Mailing Address - Country:US
Mailing Address - Phone:215-898-7021
Mailing Address - Fax:215-573-8966
Practice Address - Street 1:133 S 36TH ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3246
Practice Address - Country:US
Practice Address - Phone:215-898-7021
Practice Address - Fax:215-573-8966
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4201172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry