Healthcare Provider Details

I. General information

NPI: 1972747780
Provider Name (Legal Business Name): NICOLE MARIE HSU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 ARLINGTON BLVD
FALLS CHURCH VA
22042-2929
US

IV. Provider business mailing address

4102 PINION DR 10TH MEDICAL GROUP
USAF ACADEMY CO
80840-2502
US

V. Phone/Fax

Practice location:
  • Phone: 703-681-5682
  • Fax:
Mailing address:
  • Phone: 719-333-5142
  • Fax: 719-333-9774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberN/A
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number26212
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: