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General NPI Number Information
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NPI Number | 1205916871
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Entity Type | Organization
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Legal Business Name | ANNE M. NICKODEM, MD PC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 8229 BOONE BLVD STE 365
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City | VIENNA
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State | VA
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Zip | 22182-2623
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Country | US
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Telephone | 703-560-8711
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Fax | 703-560-8725
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Provider Business Mailing Address
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Address Line | 8229 BOONE BLVD STE 365
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City | VIENNA
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State | VA
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Zip | 22182-2623
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Country | US
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Telephone | 703-560-8711
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Fax | 703-552-2015
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANNE M NICKODEM
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Credential | M.D.
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Telephone | 703-560-8711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 0101047333
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License Number State | VA
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