Healthcare Provider Details

I. General information

NPI: 1255623815
Provider Name (Legal Business Name): NICHOLAS AH MEW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2011
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW 5TH FLOOR RESEARCH, SUITE 5700
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

111 MICHIGAN AVE NW SUITE 1950
WASHINGTON DC
20010-2916
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-6177
  • Fax:
Mailing address:
  • Phone: 202-476-2820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberMD037189
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: