Individual
DR. CHARLES D NICOLAIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4000 MEDICAL CENTER DRIVE, FAYETTEVILLE, NY 13202
(315) 744-1570
(315) 744-1940
Mailing address
4000 MEDICAL CENTER DR, FAYETTEVILLE, NY 13066
(315) 744-1570
(315) 744-1940
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
308533-01
NY
207R00000X
Internal Medicine Physician
MD454351
PA
207RC0000X
Cardiovascular Disease Physician
308533-01
NY
207RI0011X
Interventional Cardiology Physician
Primary
308533-01
NY
Other
Enumeration date
06/22/2012
Last updated
04/17/2023
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