Provider Demographics
NPI:1780411066
Name:NICLAUS, WILLIAM F (PA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:F
Last Name:NICLAUS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 RODMOR RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4924
Mailing Address - Country:US
Mailing Address - Phone:610-853-9654
Mailing Address - Fax:
Practice Address - Street 1:229 RODMOR RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4924
Practice Address - Country:US
Practice Address - Phone:610-853-9654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001955L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical