| David E. Nicodemus, Jr. | |
|
1623 Morgantown Rd Reading PA 19607-9455 | |
| (610) 796-6422 | |
| (610) 796-6470 |
| Full Name | David E. Nicodemus, Jr. |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 1623 Morgantown Rd, Reading, Pennsylvania |
| Authorized Official Name and Position | David Edward Nicodemus (OWNER) |
| Authorized Official Contact | 6109213172 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| David E. Nicodemus, Jr. 700 Carolina Ave Reading PA 19605-1102 Ph: (610) 921-3172 | David E. Nicodemus, Jr. 1623 Morgantown Rd Reading PA 19607-9455 Ph: (610) 796-6422 |
| NPI Number | 1790133742 |
|---|---|
| Provider Enumeration Date | 06/01/2016 |
| Last Update Date | 06/01/2016 |
| Medicare PECOS PAC ID | 0547553257 |
|---|---|
| Medicare Enrollment ID | O20160718002031 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790133742 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | PS007441L (Pennsylvania) | Primary |
| 103TC0700X | Psychologist - Clinical | PS007441L (Pennsylvania) | Secondary |
| Provider Name | David Edward Nicodemus |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1508083916 PECOS PAC ID: 1456644160 Enrollment ID: I20160718002084 |
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