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General NPI Number Information
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NPI Number | 1417261256
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Entity Type | Organization
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Legal Business Name | NICANOR B. CONCEPCION, M.D. P.C.
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Dates
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Enumeration Date | 08/04/2010
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Last Update Date | 08/04/2010
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Provider Practice Location Address
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Address Line | 624 PARK AVENUE
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City | NORTON
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State | VA
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Zip | 24273-0909
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Country | US
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Telephone | 276-679-6145
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 1171
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City | NORTON
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State | VA
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Zip | 24273-0909
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Country | US
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Telephone | 276-679-6145
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | NICANOR B. CONCEPCION
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Credential | M.D.
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Telephone | 276-679-6145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 0101037635
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License Number State | VA
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