Provider Demographics
NPI:1356607584
Name:FITZCHARLES, NIKITA (MD)
Entity type:Individual
Prefix:
First Name:NIKITA
Middle Name:
Last Name:FITZCHARLES
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 1:110 W SQUANTUM ST
Mailing Address - Street 2:
Mailing Address - City:NORTH QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2122
Mailing Address - Country:US
Mailing Address - Phone:617-376-3000
Mailing Address - Fax:617-774-1905
Practice Address - Street 1:180 GEORGE WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:HULL
Practice Address - State:MA
Practice Address - Zip Code:02045-3069
Practice Address - Country:US
Practice Address - Phone:781-925-4550
Practice Address - Fax:781-925-5052
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program