Provider Demographics
NPI:1699945196
Name:TKESHELASHVILI, NICK (MD)
Entity type:Individual
Prefix:
First Name:NICK
Middle Name:
Last Name:TKESHELASHVILI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1301 ALICEANNA ST APT 1811
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-3270
Mailing Address - Country:US
Mailing Address - Phone:443-870-3750
Mailing Address - Fax:443-870-3754
Practice Address - Street 1:1301 ALICEANNA ST APT 1811
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-3270
Practice Address - Country:US
Practice Address - Phone:443-870-3750
Practice Address - Fax:443-870-3754
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2020-10-21
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0106XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular-Interventional Technology