Provider Demographics
NPI:1447255203
Name:NIKITINA, SVETLANA (MD)
Entity type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:NIKITINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:
Other - Last Name:NIKITINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:830 OLD LANCASTER RD
Mailing Address - Street 2:STE 105NORTH
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3118
Mailing Address - Country:US
Mailing Address - Phone:610-527-1165
Mailing Address - Fax:610-527-6611
Practice Address - Street 1:830 OLD LANCASTER RD
Practice Address - Street 2:STE 105NORTH
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3118
Practice Address - Country:US
Practice Address - Phone:610-527-1165
Practice Address - Fax:610-527-6611
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421207207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010811310009Medicaid
PA080239F7EMedicare ID - Type UnspecifiedMEDICARE
PA1010811310009Medicaid