Provider Demographics
NPI:1346659570
Name:ROHDE, NICHOLAS CHARLES EDWARD
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:CHARLES EDWARD
Last Name:ROHDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4946 JUNO RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-2244
Mailing Address - Country:US
Mailing Address - Phone:715-330-8342
Mailing Address - Fax:
Practice Address - Street 1:4946 JUNO RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-2244
Practice Address - Country:US
Practice Address - Phone:715-330-8342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman