Individual
NICHOLAS THEODORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 N WOLFE ST, MEYER 7109, BALTIMORE, MD 21287-0005
(410) 955-4424
Mailing address
PO BOX 64286, BALTIMORE, MD 21264-4286
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
D81128
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
738693
—
AZ
Enumeration date
09/20/2005
Last updated
07/07/2016
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