Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 0101228435 | VA |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 0101228435 | VA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 0101228435 | VA |
NPI | 1053347419 |
---|---|
Provider Name | Nicholas A Midis |
First Address | Virginia Beach, VA 23462-1784 |
Second Address | Virginia Beach, VA 23462-1784 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2006 |
Last Update Date | 01/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H09429 | (02) | VA |