Provider Demographics
NPI:1366582835
Name:PATELLIS, NICHOLAS A (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:A
Last Name:PATELLIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:800-480-5243
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:382 SLAUGHTER RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2008
Practice Address - Country:US
Practice Address - Phone:256-428-1096
Practice Address - Fax:256-428-1098
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2023-08-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ALMD.30132207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPENDINGMedicaid
ALPENDINGMedicaid