Provider Demographics
NPI:1902069933
Name:MASIAN, NICOLE M (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:M
Last Name:MASIAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:BOX 70431
Mailing Address - Street 2:WILLIAM L. JENKINS FORENSIC CENTER, ETSU/QUILLEN COM
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37614
Mailing Address - Country:US
Mailing Address - Phone:423-439-8038
Mailing Address - Fax:423-439-8070
Practice Address - Street 1:MAGNOLIA AND FIFTH STREET
Practice Address - Street 2:BUILDING 6
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-439-8038
Practice Address - Fax:423-439-8070
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101248381207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology