Individual
DR. EDWARD PETER NIKICICZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
801 S ADAMS ST, SRMC, LAB, PETERSBURG, VA 23803-5149
(804) 862-5028
Mailing address
3908 MCTYRES COVE CT, MIDLOTHIAN, VA 23112-4665
(804) 744-6140
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
—
6600727
—
VA
Enumeration date
10/11/2006
Last updated
07/02/2009
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