Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Nicholas Theodore Koen

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1962031856

Nicholas Theodore Koen is a Student in an Organized Health Care Education/Training Program in Worcester, Massachusetts. Practices as a sole proprietor. Licensed in Massachusetts.

Licensed in
MA
In the registry since
2020
Specialties on file
2

Practice location Address checks out

55 Lake Ave N
Worcester, MA 01655-0002
Phone: (978) 223-8500
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence 294457 (MA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1962031856
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedApril 3, 2020
Last updated in NPPESDecember 5, 2024
Certification dateDecember 5, 2024
Mailing address55 Lake Ave N, Worcester, MA 01655-0002

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