| Doctor Name: | DR. NICK MARAVICH |
| NPI Number: | 1104828599 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 25MA06540900 |
| Business Practice Address: | 210 Ark Rd Mount Laurel, NJ - 080543188 |
| Business Phone Number: | 8567788860 |
| Business Fax Number: | 6092614180 |
| Mailing Address: | 1295 Route 38, P.o. Box 479 HAINESPORT |
| State: | NJ |
| Postal Code: | 080362702 |
| Phone Number: | 6092617017 |
| Fax Number: | 6092614180 |
| NPI Enumeration Date: | 08/15/2005 |
| NPI Last Update Date: | 04/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085R0202X |
| License Number: | 25MA06540900 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Diagnostic Radiology |
| Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |