Organization
EDWARD P. NIKICICZ, M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD PETER NIKICICZ M.D. (PRESIDENT)
(804) 862-5028
Entity
Organization
Contact information
Practice address
200 MEDICAL PARK BLVD, PETERSBURG, VA 23805-9274
(804) 765-5026
Mailing address
3908 MCTYRES COVE CT, MIDLOTHIAN, VA 23112-4665
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
VA0101047885
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
086358
BCBS
VA
05
—
6600722
—
VA
Enumeration date
11/14/2006
Last updated
12/15/2010
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