Individual
NICHOLAS HELLER LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
620 JOHN PAUL JONES CIR, PORTSMOUTH, VA 23708-2111
(858) 525-2842
Mailing address
4601 PARK RD STE 300, CHARLOTTE, NC 28209-2290
(704) 323-2505
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
—
207X00000X
Orthopaedic Surgery Physician
2020-02932
NC
207XS0106X
Orthopaedic Hand Surgery Physician
Primary
29393
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0397730007
NSC#
NC
Enumeration date
05/27/2015
Last updated
08/23/2022
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