Provider Demographics
NPI:1063476083
Name:AUDEH, NICHOLAS (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:AUDEH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:200 PROVIDENCE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1468
Mailing Address - Country:US
Mailing Address - Phone:704-749-5800
Mailing Address - Fax:704-973-0815
Practice Address - Street 1:760 MCGUIRE PL
Practice Address - Street 2:1ST FLOOR
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1630
Practice Address - Country:US
Practice Address - Phone:757-596-2762
Practice Address - Fax:757-595-2001
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2016-01-13
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Provider Licenses
StateLicense IDTaxonomies
VA0101052183207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00X147V15Medicare PIN