Individual
DR. NICHOLAS B COUNTRYMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7910 N SHADELAND AVE, INDIANAPOLIS, IN 46250-2041
(317) 516-5000
(317) 516-5146
Mailing address
10507 HYDE PARK, CARMEL, IN 46032-8300
(317) 853-6227
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
01069284A
IN
207N00000X
Dermatology Physician
2009-00203
NC
207ND0101X
MOHS-Micrographic Surgery Physician
01069284A
IN
207ND0101X
MOHS-Micrographic Surgery Physician
2009-00203
NC
Other
Enumeration date
05/29/2008
Last updated
04/05/2021
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