Provider Demographics
NPI:1629496518
Name:CRESCE, NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:CRESCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9816 MAYLAND DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1457
Mailing Address - Country:US
Mailing Address - Phone:804-282-8510
Mailing Address - Fax:804-285-5750
Practice Address - Street 1:9816 MAYLAND DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1457
Practice Address - Country:US
Practice Address - Phone:804-282-8510
Practice Address - Fax:804-285-5750
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-28
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101264211207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty