Provider Demographics
NPI:1417261256
Name:NICANOR B. CONCEPCION, M.D. P.C.
Entity Type:Organization
Organization Name:NICANOR B. CONCEPCION, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NICANOR
Authorized Official - Middle Name:B
Authorized Official - Last Name:CONCEPCION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-679-6145
Mailing Address - Street 1:P.O. BOX 1171
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-0909
Mailing Address - Country:US
Mailing Address - Phone:276-679-6145
Mailing Address - Fax:
Practice Address - Street 1:624 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-0909
Practice Address - Country:US
Practice Address - Phone:276-679-6145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037635208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7554796Medicaid
VAB60216Medicare UPIN