Individual
DR. NICHOLAS WILLIAM KOUTRELAKOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10710 CHARTER DR, SUITE G020, COLUMBIA, MD 21044-3128
(410) 964-2212
(410) 964-0380
Mailing address
10710 CHARTER DR, SUITE G020, COLUMBIA, MD 21044-3128
(410) 964-2212
(410) 964-0380
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
D0038509
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
533151000
—
MD
Enumeration date
02/20/2006
Last updated
03/18/2021
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