NPIMap

Organization Active NPI

Lake Mary OB/GYN

  • Gynecology Physician
  • Lake Mary, FL
National Provider Identifier
1679669808
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
Legal business name
LAKE MARY OB/GYN
Practice address
2500 W Lake Mary Blvd
Suite 109
Lake Mary, FL 32746-3501
Phone
(407) 323-2727
Fax
(407) 323-2771
NPI assigned
Oct 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Erika Nichelson, DO
Title
DO
Phone
(407) 323-2727

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207VG0400X Primary

Addresses

Primary practice location

2500 W Lake Mary Blvd
Suite 109
Lake Mary, FL 32746-3501

Mailing address

2500 W Lake Mary Blvd
Suite 109
Lake Mary, FL 32746-3501
Phone (407) 323-2727

National Provider Directory

National Provider Directory
Tax ID family
Edmund Boulting MD PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1679669808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 W LAKE MARY BLVD",
            "address_2": "SUITE 109",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463501",
            "telephone_number": "407-323-2727",
            "fax_number": "407-323-2771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 W LAKE MARY BLVD",
            "address_2": "SUITE 109",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463501",
            "telephone_number": "407-323-2727",
            "fax_number": "407-323-2771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MARY OB/GYN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NICHELSON",
        "authorized_official_first_name": "ERIKA",
        "authorized_official_title_or_position": "DO",
        "authorized_official_telephone_number": "407-323-2727",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Mary, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.