Individual
NICKOLAS L. PEZZELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2012 MEADE PKWY, SUFFOLK, VA 23434-4259
(757) 538-0102
(757) 538-1833
Mailing address
2012 MEADE PKWY, SUFFOLK, VA 23434-4259
(757) 538-0102
(757) 538-1833
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
0101057162
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006800688
—
VA
01
—
250011832
MEDICARE RR
VA
01
—
P00799764
RR MEDICARE
VA
Enumeration date
07/20/2006
Last updated
04/08/2010
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