Provider Demographics
NPI:1700997939
Name:CAROSELLA, NICHOLAS WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:WILLIAM
Last Name:CAROSELLA
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 1:1370 WASHINGTON PIKE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-2862
Mailing Address - Country:US
Mailing Address - Phone:412-206-0123
Mailing Address - Fax:412-206-0128
Practice Address - Street 1:1370 WASHINGTON PIKE
Practice Address - Street 2:SUITE 303
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-2862
Practice Address - Country:US
Practice Address - Phone:412-206-0123
Practice Address - Fax:412-206-0128
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047902L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACA594732Medicare ID - Type Unspecified
PAE36912Medicare UPIN