Healthcare Provider Details

I. General information

NPI: 1881667392
Provider Name (Legal Business Name): LEIF O NORDBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 QUIET CV
FAYETTEVILLE NC
28304-3985
US

IV. Provider business mailing address

2001 W MAIN ST SUITE 150
STAMFORD CT
06902-4501
US

V. Phone/Fax

Practice location:
  • Phone: 910-829-6588
  • Fax: 910-615-9692
Mailing address:
  • Phone: 203-324-4700
  • Fax: 203-324-5691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number200200972
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number042356
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: