Basic Information
| Provider Information | |||||||||
| NPI: | 1497797765 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZERVANOS | ||||||||
| FirstName: | NIKITAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 N DUKE ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175445511 | ||||||||
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| Practice Location | |||||||||
| Address1: | 540 N DUKE ST | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175445511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 04/12/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD028733L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5872305 | 01 | PA | AETNA - NON HMO | OTHER | 080100819 | 01 | PA | RR MEDICARE | OTHER | 50056003 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 555775 | 01 | PA | AETNA - HMO | OTHER | 000018585 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 0038413000 | 01 | PA | AMERIHEALTH 65 / IBC | OTHER | 000000127113 | 01 | PA | UNISON | OTHER | 000611123 0003 | 05 | PA | MEDICAID | 100338H | 01 | PA | AMERIHEALTH MERCY | OTHER | P002762 | 01 | PA | GATEWAY | OTHER |