Individual
MARIA NICCUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD, MSC
Contact information
Practice address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
(215) 327-2746
Mailing address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
MT222192
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/20/2018
Last updated
07/24/2021
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