Healthcare Provider Details

I. General information

NPI: 1043296734
Provider Name (Legal Business Name): MARC H NUDELMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 GRANDIFLORA DR # 102
LELAND NC
28451-7453
US

IV. Provider business mailing address

3040 W SALT CREEK LN
ARLINGTON HEIGHTS IL
60005-1069
US

V. Phone/Fax

Practice location:
  • Phone: 910-371-3213
  • Fax:
Mailing address:
  • Phone: 847-870-4780
  • Fax: 847-483-7447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2021-02441
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: