Provider Demographics
NPI:1245985811
Name:NICKEL BRIDGE FAMILY MEDICINE
Entity type:Organization
Organization Name:NICKEL BRIDGE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:DIANA
Authorized Official - Last Name:DIPASQUALE SEELIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-293-0821
Mailing Address - Street 1:1405 WESTOVER HILLS BLVD STE 1A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-3153
Mailing Address - Country:US
Mailing Address - Phone:804-293-0821
Mailing Address - Fax:
Practice Address - Street 1:1405 WESTOVER HILLS BLVD STE 1A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-3153
Practice Address - Country:US
Practice Address - Phone:804-293-0821
Practice Address - Fax:866-293-4718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-12
Last Update Date:2024-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty