MEDICARE: DR. NICHOLAS CHARLES SORREL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	206272	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700131950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS CHARLES SORREL MD

Provider Business Mailing Address
First Line	:	604 NORTH ACADIA STE 101
Second Line	:
City	:	THIBODAUX
State	:	LA
Zip	:	70301-4897
Country	:	US
Telephone Number	:	985-446-5079
Fax Number	:	985-447-2497

Provider Business Practice Location Address
First Line	:	2308 E MAIN ST STE B
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70560-4029
Country	:	US
Telephone Number	:	337-369-3683
Fax Number	:	877-796-4339

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2012
Last Update Date	:	02/26/2026

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