Basic Information
| Provider Information | |||||||||
| NPI: | 1578525457 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NICODEMUS | ||||||||
| FirstName: | HONORATO | ||||||||
| MiddleName: | FENOL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13110 FOXDEN DR | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208503404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012792092 | ||||||||
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| Practice Location | |||||||||
| Address1: | NAT. NAV. MED. CEN. | ||||||||
| Address2: | WISCONSIN AVE | ||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 19103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012954455 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | D0021096 | MD | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.