NICHOLAS CARROLL DESTEFANO (MD) – General Practice Physician, NPI 1154776755

General Practice Physician

NICHOLAS CARROLL DESTEFANO (MD) is a healthcare provider. based in Tacoma, Washington. specializing in FAMILY PRACTICE. They hold the professional credentials MD. They hold a License No. 30177 (NE). The NPI Number for NICHOLAS CARROLL DESTEFANO (MD) is 1154776755

Main info

Male

10 Years Of Experience

Accepts Medicare Assignment

Name

NICHOLAS CARROLL DESTEFANO (MD)

NPI

1154776755

Phone

(253) 968-1340

Address

9040 FITZSIMMONS DR

Enumeration Date

2 May 2016

Last Update Date

10 December 2025

Doctor Profile

Medical School Name

WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE

Secondary Phone

3026453525

Graduation Year

2016 (10 years ago)

PAC ID

0446542229

Group Practice PAC ID

5496744864

Professional Enrollment ID

I20251219002133

Address ID

DE199581462LE424XXRDXX300

Data current as of

20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience58

Completeness85

Years active:10State licenses:2Digital endpointsOther names

4,141 FAMILY PRACTICE in WA

Provider Addresses for NICHOLAS CARROLL DESTEFANO (MD)

9040 FITZSIMMONS DR
TACOMA, WA 984311000
Phone: (253) 968-1340
Type: Mailing
300 E HOSPITAL RD
FORT GORDON, GA 30905
Phone: (706) 383-5299
Type: Location
36223 Farm Ln Ste 140
Rehoboth Beach, DE 199711329
Phone: (302) 227-1268
Fax: (302) 227-1287
Type: Location
1008 Kings Hwy
Lewes, DE 199581932
Phone: (302) 291-6031
Fax: (833) 954-4028
Type: Location
36450 Tidal Rd Unit 2
Selbyville, DE 199754596
Phone: (302) 291-6045
Fax: (833) 449-3867
Type: Location
18947 John J Williams Hwy Unit 303
Rehoboth Beach, DE 199714477
Phone: (302) 644-0690
Fax: (302) 644-0695
Type: Location
23900 Milton Ellendale Hwy Ste 101
Milton, DE 199682714
Phone: (302) 684-2033
Fax: (888) 987-4302
Type: Location
32550 Docs Pl Unit 2
Millville, DE 199676975
Phone: (302) 539-4302
Fax: (302) 645-4766
Type: Location
232 Mitchell St Unit 301
Millsboro, DE 199669412
Phone: (302) 316-4190
Fax: (302) 934-1207
Type: Location
100 Silicato Pkwy Ste 201
Milford, DE 199631273
Phone: (302) 393-2056
Fax: (302) 422-9359
Type: Location
21635 Biden Ave Unit 101
Georgetown, DE 199474575
Phone: (302) 856-9596
Fax: (302) 645-4744
Type: Location
17388 N Village Main Blvd Unit 21
Lewes, DE 199587240
Phone: (302) 291-6050
Fax: (833) 450-5311
Type: Location
12100 Black Swan Dr Ste 104
Lewes, DE 199584991
Phone: (302) 645-1315
Fax: (302) 644-2739
Type: Location
424 Savannah Rd
Lewes, DE 199581462
Phone: (302) 645-3150
Fax: (833) 908-2232
Type: Location
32050 Long Neck Rd
Millsboro, DE 199666228
Phone: (302) 645-3150
Fax: (833) 908-2232
Type: Location
28538 DuPont Blvd Unit 1
Millsboro, DE 199664791
Phone: (302) 829-3294
Fax: (833) 314-0538
Type: Location
390 N LOOP RD
FORT IRWIN, CA 92310
Phone: (760) 383-5200
Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-12-19

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

Medicare enrolled
On CMS revalidation list
Due date assigned
Revalidate in PECOS

CMS enrollment records

Enrollment ID	Type	Specialty	State	Due date
I20251219002133	I	Family Practice	DE	TBD

What to do next

No action required while the due date shows TBD.
Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 98431)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 5496744864View full group profile

Name	Specialty	State
DR. CYNTHIA LAMOUR (DO)	Family Practice	NY
DR. NIKHIL CHINMAYA (DO)	-	PA
DR. GEORGE M. KLUCHNIK (MD)	Internal Medicine	DE
DR. DOUGLAS B JR. ALLEN (DO)	-	DE
KIMBERLY BEDDOW	-	DE
DR. MANESHKUMAR F. PATEL (MD)	Internal Medicine	DE
DR. MARISA CONTI (DO)	Internal Medicine	DE
DR. WILLIAM M II CHASANOV (D.O.)	Infectious Disease, Internal Medicine	DE
DR. JOYCE ROBERT (MD)	Family Practice	NY
ANASTASIIA S ISRAEL (NP)	Nurse Practitioner	VA

Reviews

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Frequently asked questions

What unique ID ties claims to NICHOLAS CARROLL DESTEFANO (MD)?

NPI 1154776755 is assigned to NICHOLAS CARROLL DESTEFANO (MD) under the national enumeration system.

Does this profile mean NICHOLAS CARROLL DESTEFANO (MD) is currently active?

Yes — NICHOLAS CARROLL DESTEFANO (MD) appears active in the national provider directory.

Can you summarize NICHOLAS CARROLL DESTEFANO (MD)'s specialty in plain language?

Clinically, the directory lists NICHOLAS CARROLL DESTEFANO (MD) with General Practice Physician. Clinical services aligned with this taxonomy classification.

Where is NICHOLAS CARROLL DESTEFANO (MD)'s primary listing?

We display Tacoma, Washington because that is what the record indicates for NICHOLAS CARROLL DESTEFANO (MD).

How can I contact NICHOLAS CARROLL DESTEFANO (MD)?

Phone or fax may appear on the official NPI record when supplied — verify before relying on them.