Provider Demographics
NPI:1912973926
Name:GRUPKA, NICHON L (MD)
Entity type:Individual
Prefix:DR
First Name:NICHON
Middle Name:L
Last Name:GRUPKA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3333 SILAS CREEK PKWY
Mailing Address - Street 2:FMC, DEPT OF PATHOLOGY
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3013
Mailing Address - Country:US
Mailing Address - Phone:336-718-5856
Mailing Address - Fax:336-718-9259
Practice Address - Street 1:3333 SILAS CREEK PKWY
Practice Address - Street 2:FMC, DEPT OF PATHOLOGY
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3013
Practice Address - Country:US
Practice Address - Phone:336-718-5856
Practice Address - Fax:336-718-9259
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA81931207ZP0102X
TN55245207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903698Medicaid
NC2054627Medicare PIN
NC5903698Medicaid