Provider Demographics
NPI:1306033451
Name:NEGOITA, NICOLETA (PA-C)
Entity type:Individual
Prefix:
First Name:NICOLETA
Middle Name:
Last Name:NEGOITA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NICOLETA
Other - Middle Name:
Other - Last Name:PRICOPIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6535 N CHARLES ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5823
Mailing Address - Country:US
Mailing Address - Phone:410-321-1195
Mailing Address - Fax:410-321-1197
Practice Address - Street 1:6535 N CHARLES ST STE 200
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-5823
Practice Address - Country:US
Practice Address - Phone:410-321-1195
Practice Address - Fax:410-321-1197
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011969-1363AS0400X
MDC0003910363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY471520001OtherMEDICARE DME
NYPA2336Medicare PIN
NY471520001OtherMEDICARE DME