Provider Demographics
NPI:1578525457
Name:NICODEMUS, HONORATO FENOL (MD)
Entity Type:Individual
Prefix:DR
First Name:HONORATO
Middle Name:FENOL
Last Name:NICODEMUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13110 FOXDEN DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3404
Mailing Address - Country:US
Mailing Address - Phone:301-279-2092
Mailing Address - Fax:
Practice Address - Street 1:NAT. NAV. MED. CEN.
Practice Address - Street 2:WISCONSIN AVE
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:19103
Practice Address - Country:US
Practice Address - Phone:301-295-4455
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0021096207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology