Provider Demographics
NPI:1801868963
Name:NICOLOFF, NICOLA B (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLA
Middle Name:B
Last Name:NICOLOFF
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 1:2999 INNOVATION WAY
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-7903
Mailing Address - Country:US
Mailing Address - Phone:724-983-1800
Mailing Address - Fax:724-983-8252
Practice Address - Street 1:2999 INNOVATION WAY
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-7903
Practice Address - Country:US
Practice Address - Phone:724-983-1800
Practice Address - Fax:724-983-8252
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35038317207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0472260Medicaid
OHNI0479754Medicare ID - Type Unspecified
A79519Medicare UPIN