Individual
DR. BRENT M NICKISCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
443 ENGLISH RD, BATH, PA 18014
(610) 390-5596
Mailing address
443 ENGLISH RD, BATH, PA 18014-9210
(610) 390-5596
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
OS008986L
PA
207R00000X
Internal Medicine Physician
Primary
OS008986L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0311501
BLUE SHIELD
PA
01
—
11585351
CAQH#
PA
Enumeration date
06/26/2006
Last updated
07/16/2018
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