Provider Demographics
NPI:1801849609
Name:NOWICKY, DAVID J (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:NOWICKY
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 1:5033 MILFORD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-2861
Mailing Address - Country:US
Mailing Address - Phone:980-254-8405
Mailing Address - Fax:
Practice Address - Street 1:3315 SPRINGBANK LN
Practice Address - Street 2:SUITE 202
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3197
Practice Address - Country:US
Practice Address - Phone:704-997-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200201133208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5525536OtherAETNA
NC1317VOtherBLUE CROSS
G60136Medicare UPIN
NC1317VOtherBLUE CROSS