Provider Demographics
NPI:1487617387
Name:NECHES, NORMAN M (MD)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:M
Last Name:NECHES
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 1:10719 MCGREGOR DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4956
Mailing Address - Country:US
Mailing Address - Phone:202-365-7144
Mailing Address - Fax:301-424-5699
Practice Address - Street 1:10719 MCGREGOR DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-4956
Practice Address - Country:US
Practice Address - Phone:202-365-7144
Practice Address - Fax:301-424-5699
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103727207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03106392Medicaid
NYJ400089826Medicare PIN
NYJ400148540Medicare PIN
B95149Medicare UPIN