Individual
DR. NIKKITA F SOUTHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
22 S GREENE ST, BALTIMORE, MD 21201-1544
(410) 328-5756
(410) 328-0267
Mailing address
PO BOX 64442, BALTIMORE, MD 21264-4442
(410) 328-5756
(410) 328-0267
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D63236
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4103521-00
—
MD
01
—
647060-01
BLUE CROSS/BLUE SHIELD
MD
Enumeration date
05/10/2006
Last updated
02/21/2014
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