Basic Information
Provider Information
NPI: 1003006172
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: QUEZADA
FirstName: NESTOR
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 19305
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282199305
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 4539 HEDGEMORE DR
Address2: STE 100
City: CHARLOTTE
State: NC
PostalCode: 282093276
CountryCode: US
TelephoneNumber: 7043319669
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/25/2007
LastUpdateDate: 04/20/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0200X2018-01644NCY Allopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease

No ID Information.


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