Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Nicholas Fanselow

Individual provider Military Health Care Provider · NPI 1003675109

Nicholas Fanselow is a Military Health Care Provider in Portsmouth, Virginia. Licensed in Virginia. Registered with an NPI since 2024.

Licensed in
VA
In the registry since
2024
Specialties on file
3

Practice location Address checks out

620 John Paul Jones Cir
Portsmouth, VA 23708-2111
Phone: (757) 953-0669
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Physician (primary) Taxonomy 208D00000X · Licence 0101286704 (VA)
Military Health Care Provider Taxonomy 171000000X
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1003675109
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 19, 2024
Last updated in NPPESSeptember 26, 2025
Certification dateSeptember 26, 2025

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