Provider Demographics
NPI:1336154533
Name:OUILIKON, NEVA A (MD)
Entity Type:Individual
Prefix:
First Name:NEVA
Middle Name:A
Last Name:OUILIKON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 N VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:REINHOLDS
Mailing Address - State:PA
Mailing Address - Zip Code:17569-9320
Mailing Address - Country:US
Mailing Address - Phone:717-484-5140
Mailing Address - Fax:717-484-5143
Practice Address - Street 1:16 N VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:REINHOLDS
Practice Address - State:PA
Practice Address - Zip Code:17569-9320
Practice Address - Country:US
Practice Address - Phone:717-484-5140
Practice Address - Fax:717-484-5143
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424203207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001612737OtherBLUE SHIELD
PA101098676Medicaid
PAP00261146OtherRAILROAD MEDICARE
PA078930Medicare ID - Type Unspecified
PA001612737OtherBLUE SHIELD