Provider Demographics
NPI:1649406117
Name:HORST, NICOLE DRAY (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:DRAY
Last Name:HORST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:DRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:81 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2714
Mailing Address - Country:US
Mailing Address - Phone:978-741-1200
Mailing Address - Fax:978-740-4856
Practice Address - Street 1:81 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2714
Practice Address - Country:US
Practice Address - Phone:978-741-1200
Practice Address - Fax:978-740-4856
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2579052085R0202X
SCMD317502085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology