Provider Demographics
NPI:1205880358
Name:VETERE, NICOLE S (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:S
Last Name:VETERE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:S
Other - Last Name:EVANCICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9901 MEDICAL CENTER DRIVE
Mailing Address - Street 2:SHADY GROVE ADVENTIST HOSPITAL ATTN: MEP
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20878
Mailing Address - Country:US
Mailing Address - Phone:240-826-7550
Mailing Address - Fax:
Practice Address - Street 1:9901 MEDICAL CENTER DRIVE
Practice Address - Street 2:SHADY GROVE ADVENTIST HOSPITAL
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20878
Practice Address - Country:US
Practice Address - Phone:240-826-7550
Practice Address - Fax:240-364-9020
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064079207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD019746M30Medicare PIN
DCP00338458Medicare PIN
DC019746M30Medicare PIN