Edward P. Nikicicz, M.D., P.C.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

VA0101047885 Issued in VA

Legal business name

EDWARD P. NIKICICZ, M.D., P.C.

Practice address

200 Medical Park Blvd
Petersburg, VA 23805-9274

Phone

(804) 765-5026

NPI assigned

Nov 14, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Edward Peter Nikicicz, M.D.

Title

President

Phone

(804) 862-5028

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292371200000",
    "number": "1154493534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3908 MCTYRES COVE CT",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231124665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MEDICAL PARK BLVD",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059274",
            "telephone_number": "804-765-5026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD P. NIKICICZ, M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2010-12-15",
        "status": "A",
        "authorized_official_last_name": "NIKICICZ",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "PETER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "804-862-5028",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "VA",
            "license": "VA0101047885",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6600722",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "086358",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Anatomic Pathology & Clinical Pathology Physician in Petersburg, VA
• Providers in Petersburg, VA by specialty
• Anatomic Pathology & Clinical Pathology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.