Provider Demographics
NPI:1700887197
Name:NICOL, PHILIP DUNBAR (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:DUNBAR
Last Name:NICOL
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 1:127 ONEIDA VALLEY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-2239
Mailing Address - Country:US
Mailing Address - Phone:866-620-6761
Mailing Address - Fax:724-282-3043
Practice Address - Street 1:127 ONEIDA VALLEY RD
Practice Address - Street 2:SUITE 400
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-2239
Practice Address - Country:US
Practice Address - Phone:866-620-6761
Practice Address - Fax:724-282-3043
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049708L207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014235940013Medicaid
OH2589140Medicaid
PA0014235940013Medicaid
PAF64470Medicare UPIN
PA049271NJQMedicare PIN