Basic Information
| Provider Information | |||||||||
| NPI: | 1689965790 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCALZITTI | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3551 ROGER BROOKE DR | ||||||||
| Address2: | QUALITY SERVICES/7TH FLOOR | ||||||||
| City: | FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782344504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109162338 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3551 ROGER BROOKE DR | ||||||||
| Address2: | |||||||||
| City: | FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782344504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109162367 | ||||||||
| FaxNumber: | 2109168366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2011 | ||||||||
| LastUpdateDate: | 12/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 036.144473 | IL | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 27072 | NE | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207YS0012X | 27072 | NE | N | Allopathic & Osteopathic Physicians | Otolaryngology | Sleep Medicine | 207Y00000X | R6278 | TX | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.