Basic Information
| Provider Information | |||||||||
| NPI: | 1235384561 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | QUERCETTI | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1941 LIMESTONE RD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198085413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026333555 | ||||||||
| FaxNumber: | 3026333559 | ||||||||
| Practice Location | |||||||||
| Address1: | 1941 LIMESTONE RD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198085413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026333555 | ||||||||
| FaxNumber: | 3026333559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2008 | ||||||||
| LastUpdateDate: | 11/25/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | C2-0010961 | DE | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | P01348209 | 01 | DE | RAILROAD | OTHER | 1235384561 | 05 | DE | MEDICAID |