Provider Demographics
NPI:1740676535
Name:AGATHIS, NICKOLAS THEOPHILOS (MD (IN MAY 2015))
Entity type:Individual
Prefix:
First Name:NICKOLAS
Middle Name:THEOPHILOS
Last Name:AGATHIS
Suffix:
Gender:M
Credentials:MD (IN MAY 2015)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10364 COLLEGE SQ
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4659
Mailing Address - Country:US
Mailing Address - Phone:908-739-7500
Mailing Address - Fax:
Practice Address - Street 1:8901 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-2724
Practice Address - Country:US
Practice Address - Phone:301-400-0408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA87978208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics