Provider Demographics
NPI:1669531315
Name:NILLES, PATRICIA A (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:NILLES
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 1:33 BARTLETT ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1334
Mailing Address - Country:US
Mailing Address - Phone:978-934-8449
Mailing Address - Fax:781-721-5162
Practice Address - Street 1:33 BARTLETT ST
Practice Address - Street 2:SUITE 204
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1334
Practice Address - Country:US
Practice Address - Phone:978-934-8449
Practice Address - Fax:781-721-5162
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG81445207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA235401Medicaid
CA00G814450Medicaid
MA235401Medicaid