Provider Demographics
NPI:1700892676
Name:STETTLER, NICOLAS A (MD)
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:A
Last Name:STETTLER
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 1:3130 FAIRVIEW PARK DR STE 500
Mailing Address - Street 2:THE LEWIN GROUP
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-4517
Mailing Address - Country:US
Mailing Address - Phone:703-269-5535
Mailing Address - Fax:
Practice Address - Street 1:3130 FAIRVIEW PARK DR STE 500
Practice Address - Street 2:THE LEWIN GROUP
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-4517
Practice Address - Country:US
Practice Address - Phone:703-269-5535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066875L208000000X, 2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001800090Medicaid
NJ8218706Medicaid
PA001800090Medicaid
NJ8218706Medicaid