Provider Demographics
NPI:1770279390
Name:DR. DEBORAH NILES PLLC
Entity type:Organization
Organization Name:DR. DEBORAH NILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ALTHEA
Authorized Official - Last Name:NILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-450-1271
Mailing Address - Street 1:651 E TOWNSHIP LINE ROAD
Mailing Address - Street 2:#101
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-5003
Mailing Address - Country:US
Mailing Address - Phone:215-450-1271
Mailing Address - Fax:215-893-8588
Practice Address - Street 1:134 ASHLEY WAY
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-2854
Practice Address - Country:US
Practice Address - Phone:215-450-1271
Practice Address - Fax:215-450-1271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty