Provider Demographics
NPI:1104023829
Name:WEBER, NICOLE LEANN (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:LEANN
Last Name:WEBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LEANN
Other - Last Name:SHARKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:33 LEWIS RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-1048
Mailing Address - Country:US
Mailing Address - Phone:607-729-8156
Mailing Address - Fax:
Practice Address - Street 1:33-57 HARRISON ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2107
Practice Address - Country:US
Practice Address - Phone:607-763-6101
Practice Address - Fax:607-763-5180
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2024-05-22
Deactivation Date:2024-04-10
Deactivation Code:
Reactivation Date:2024-04-26
Provider Licenses
StateLicense IDTaxonomies
CAA89650207V00000X
NY280500207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology