Nicholas William Koutrelakos, M.D.

Primary specialty

Medical Oncology PhysicianTaxonomy code 207RX0202X

License

D0038509 Issued in MD

Practice address

10710 Charter Dr
Suite G020
Columbia, MD 21044-3128

Phone

(410) 964-2212

Fax

(410) 964-0380

NPI assigned

Feb 20, 2006

Last updated

Mar 18, 2021By the provider in NPPES

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 MD

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

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nicholas.koutrelakos@mdonc.ikm.direct-ci.com

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

• Upmc Western Maryland Corporation

  dba UPMC Western Maryland

  • Internal Medicine Physician
  • Cumberland, MD
  • NPI 1184769952
  Medicare reassignment NPD
• Upmc Western Maryland Health Services, LLC

  • Internal Medicine Physician
  • Cumberland, MD
  • NPI 1447976584
  Medicare reassignment NPD
• Maryland Oncology Hematology P.a.

  • Hematology & Oncology Physician
  • Columbia, MD
  • NPI 1396710703
  Authorized official Same address or phone
• Upmc Western Maryland Corporation

  dba Upmc Western Maryland Center for Hope and Healing

  • Mental Illness Community Based Residential Treatment Facility
  • Cumberland, MD
  • NPI 1174141592
  NPD
• Upmc Western Maryland Health Services, LLC

  • Internal Medicine Physician
  • Cumberland, MD
  • NPI 1134844764
  NPD
• Upmc Western Maryland Health Services, LLC

  • Psychiatry Physician
  • Cumberland, MD
  • NPI 1770208308
  NPD
• Frederick Health Hospital Inc

  dba Frederick Health Hospital

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)
• University of Maryland Radiation Oncology Associates PA

  • Radiation Oncology Physician
  • Baltimore, MD
  • NPI 1780637272
  NPD (past)
• Maryland Oncology Hematology, P.a.

  • Medical Oncology Physician
  • Gettysburg, PA
  • NPI 1275827891
  NPD (past)

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

{
    "created_epoch": "1140393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616025600000",
    "number": "1912972415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10710 CHARTER DR",
            "address_2": "SUITE G020",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210443128",
            "telephone_number": "410-964-2212",
            "fax_number": "410-964-0380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10710 CHARTER DR",
            "address_2": "SUITE G020",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210443128",
            "telephone_number": "410-964-2212",
            "fax_number": "410-964-0380"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12502 Willowbrook Rd",
            "address_purpose": "LOCATION",
            "city": "Cumberland",
            "state": "MD",
            "postal_code": "215026491",
            "country_code": "US",
            "telephone_number": "240-964-8717",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12500 Willowbrook Rd",
            "address_purpose": "LOCATION",
            "city": "Cumberland",
            "state": "MD",
            "postal_code": "215026393",
            "country_code": "US",
            "telephone_number": "240-964-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOUTRELAKOS",
        "first_name": "NICHOLAS",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-20",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "MD",
            "license": "D0038509",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "533151000",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Razia Fathima Kosi, LCSW-C
• Morufat Olakunbi Kosoko, MD
• Julie Marks Kotler, LCPC, ATR-BC
• Michael Kotlicky, O.D.
• Valerie B Kouabran
• Jennifer Kouvaris, RN
• Bernice Kpadjiba, PA-C
• Felicia Gabrielle Kraft, LCSW-C
• Isabella Krall
• Taylor Kralowetz

• Medical Oncology Physician in Columbia, MD
• Providers in Columbia, MD by specialty
• Medical Oncology Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2021; 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.