Provider Demographics
NPI:1487826491
Name:NICKODEM, ANNE M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:M
Last Name:NICKODEM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:45155 RESEARCH PL STE 110
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4192
Mailing Address - Country:US
Mailing Address - Phone:703-560-8711
Mailing Address - Fax:703-552-2015
Practice Address - Street 1:45155 RESEARCH PL STE 110
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-4192
Practice Address - Country:US
Practice Address - Phone:703-560-8711
Practice Address - Fax:703-552-2015
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2023-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV0101047333208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA736626Medicare PIN