Provider Demographics
NPI:1710478649
Name:BLAIR, NICOLE (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:URPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:U.S. MARINE CORPS FORCES COMMAND
Mailing Address - Street 2:1775 FORRESTAL DRIVE BLDG NH-33
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23551
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:U.S. MARINE CORPS FORCES COMMAND
Practice Address - Street 2:1775 FORRESTAL DRIVE BLDG NH-33
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23551
Practice Address - Country:US
Practice Address - Phone:301-651-6026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-26
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351045678208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery