Provider Demographics
NPI:1144287723
Name:TELEW, NICHOLAS W (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:W
Last Name:TELEW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3203 WILLAMETTE ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3348
Mailing Address - Country:US
Mailing Address - Phone:541-726-9912
Mailing Address - Fax:541-744-4443
Practice Address - Street 1:3203 WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3348
Practice Address - Country:US
Practice Address - Phone:541-726-9912
Practice Address - Fax:541-744-4443
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17401174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR031091Medicaid
OR101314Medicare ID - Type Unspecified
OR031091Medicaid