Provider Demographics
NPI:1235384942
Name:BRATHWAITE-DINGLE, NICHOLE RENEE (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLE
Middle Name:RENEE
Last Name:BRATHWAITE-DINGLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11932 APPALOOSA WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-3876
Mailing Address - Country:US
Mailing Address - Phone:301-762-4252
Mailing Address - Fax:
Practice Address - Street 1:11932 APPALOOSA WAY
Practice Address - Street 2:
Practice Address - City:NORTH POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20878-3876
Practice Address - Country:US
Practice Address - Phone:301-762-4252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221417208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02230000Medicaid