Provider Demographics
NPI:1518245638
Name:PALACIOS MEZA, NICOLAS EDUARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:EDUARDO
Last Name:PALACIOS MEZA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:401 SHIPPAN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-6075
Mailing Address - Country:US
Mailing Address - Phone:203-658-9507
Mailing Address - Fax:
Practice Address - Street 1:63 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4042
Practice Address - Country:US
Practice Address - Phone:508-559-6699
Practice Address - Fax:508-559-5073
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA259187207R00000X
NY298582207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine