Provider Demographics
NPI:1669448791
Name:OGG, NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:OGG
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 1:104 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-8230
Mailing Address - Country:US
Mailing Address - Phone:828-645-7974
Mailing Address - Fax:828-645-9798
Practice Address - Street 1:104 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-8230
Practice Address - Country:US
Practice Address - Phone:828-645-7974
Practice Address - Fax:828-645-9798
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9901454207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89128WJMedicaid
NCH45563Medicare UPIN
NC2291879AMedicare ID - Type Unspecified