Nicole Charlotte Christacos, PH.D.

Primary specialty

Ph.D. Medical GeneticsTaxonomy code 170100000X

License

2005032 Issued in VA

Practice address

14225 Newbrook Dr
Chantilly, VA 20151-2228

Phone

(703) 802-7155

Fax

(703) 802-7103

NPI assigned

Jun 26, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340668800000",
    "number": "1346504289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14225 NEWBROOK DR",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201512228",
            "telephone_number": "703-802-7155",
            "fax_number": "703-802-7103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14225 NEWBROOK DR",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201512228",
            "telephone_number": "703-802-7155",
            "fax_number": "703-802-7103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHRISTACOS",
        "first_name": "NICOLE",
        "middle_name": "CHARLOTTE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-26",
        "last_updated": "2012-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "170100000X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Ph.D. Medical Genetics",
            "state": "VA",
            "license": "2005032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ph.D. Medical Genetics in Chantilly, VA
• Providers in Chantilly, VA by specialty
• Ph.D. Medical Genetics in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.