Carlo G Nicolis, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD432640 Issued in PA

Practice address

200 State Street
Suite 205
Media, PA 19063-3434

Phone

(610) 521-4112

Fax

(610) 521-6864

NPI assigned

Jun 23, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Alliance Physician Services, PC

  dba MidLantic Urology

  • Urology Physician
  • Paoli, PA
  • NPI 1952829350
  Medicare reassignment NPD
• Alliance Physician Services, PC

  • Urology Physician
  • King of Prussia, PA
  • NPI 1811351083
  NPD
• Alliance Physician Services, PC

  dba Associated Urologists of North Carolina

  • Urology Physician
  • Wake Forest, NC
  • NPI 1316811888
  NPD

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1841226909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 95000-3505",
            "city": "PHILA",
            "state": "PA",
            "postal_code": "191950001",
            "telephone_number": "610-382-5900",
            "fax_number": "610-382-5918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 STATE STREET",
            "address_2": "SUITE 205",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190633434",
            "telephone_number": "610-521-4112",
            "fax_number": "610-521-6864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICOLIS",
        "first_name": "CARLO",
        "middle_name": "G",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "PA",
            "license": "MD432640",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LIC NUMBER",
            "identifier": "MD432640",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca Wing-Lun NG
• Phuong Ngo, CRNP
• Viet Nguyen, PHARMD
• Lynn W Nichols, RD LDN
• Nicole Sestito, PH.D.
• Rebecca Nitka
• Claire Nitzsche
• Joanne Njenga
• Kelsey Noble
• Peter B Nonack, MD

• Specialist in Media, PA
• Providers in Media, PA by specialty
• Specialist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.