Doctor Name: | DR. NICHOLAS PAUL COSENTINO |
NPI Number: | 1013276898 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O |
License Number: | 0102203678 |
Business Practice Address: | 3551 Roger Brooke Dr Mche-qd (creds) Fort Sam Houston, TX - 782346200 |
Business Phone Number: | 2109165190 |
Business Fax Number: | |
Mailing Address: | 3551 Roger Brooke Dr, Mche-qd (creds) FORT SAM HOUSTON |
State: | TX |
Postal Code: | 782346200 |
Phone Number: | 2109165910 |
Fax Number: | |
NPI Enumeration Date: | 05/14/2012 |
NPI Last Update Date: | 04/02/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 0102203678 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |