Provider Demographics
NPI:1871855502
Name:COLACCHIO, NICHOLAS DOMINIC (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:DOMINIC
Last Name:COLACCHIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5 BUCKNAM RD STE 1D
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1208
Mailing Address - Country:US
Mailing Address - Phone:207-781-1551
Mailing Address - Fax:207-781-1552
Practice Address - Street 1:5 BUCKNAM RD STE 1D
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1208
Practice Address - Country:US
Practice Address - Phone:207-781-1551
Practice Address - Fax:207-781-1552
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD21891207X00000X
NC2017-00044207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2017-00044OtherMEDICAL LICENSE
NCNC3022Medicaid
NC1871855502Medicaid