Provider Demographics
NPI:1346450657
Name:NIDA, GEBRESELASSIE W (MD , FACE)
Entity Type:Individual
Prefix:DR
First Name:GEBRESELASSIE
Middle Name:W
Last Name:NIDA
Suffix:
Gender:M
Credentials:MD , FACE
Other - Prefix:DR
Other - First Name:GEBRE
Other - Middle Name:
Other - Last Name:NIDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD FACE
Mailing Address - Street 1:1107 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-5313
Mailing Address - Country:US
Mailing Address - Phone:336-951-6070
Mailing Address - Fax:336-634-3940
Practice Address - Street 1:1107 S MAIN ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5313
Practice Address - Country:US
Practice Address - Phone:336-951-6070
Practice Address - Fax:336-634-3940
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200900231207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism