Individual
DAVID E NICKLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
39TH AND MARKET ST, 7TH FLOOR MUTCH BLDG, PHILADELPHIA, PA 19104
(215) 662-8777
Mailing address
51 NORTH 39TH STREET, 6 MUTCH BLDG., PHILADELPHIA, PA 19104-2640
(215) 662-9144
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD027291E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010661600004
—
PA
Enumeration date
06/29/2006
Last updated
01/06/2012
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