Basic Information
| Provider Information | |||||||||
| NPI: | 1649533746 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NICOLAIS | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4000 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157441570 | ||||||||
| FaxNumber: | 3157441940 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 LOTHROP STREET | ||||||||
| Address2: | S-553 SCAIFE HALL | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152132536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126473429 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2012 | ||||||||
| LastUpdateDate: | 11/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 308533-01 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD454351 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 308533-01 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 308533-01 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
No ID Information.