Individual
NICHOLAS THEOPHILOS KIPREOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
865 W LAKE DR, MOUNT AIRY, NC 27030-2157
(336) 719-6100
(336) 719-2313
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
(276) 694-6677
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101049407
VA
207Q00000X
Family Medicine Physician
Primary
2016-00121
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005614236
—
VA
Enumeration date
07/14/2005
Last updated
06/23/2022
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