Individual Healthcare Provider
Nicholas Fanselow
Provider's NPPES record last updated: September 26, 2025
Overview
- Entity Type
- Individual Healthcare Provider
- NPI
- 1003675109
- Primary Specialty
- General Practice
- Practice Location
- Portsmouth, Virginia
- Sole Proprietor
- No
Federal Screening
NPISignal checked this NPI against federal exclusion sources. Results below are based on the NPI number itself — an identifier match, not a name match.
List of Excluded Individuals/Entities (LEIE)
HHS Office of Inspector General
No potential match was identified in NPISignal's indexed List of Excluded Individuals/Entities (LEIE) records as of 2026-09-10.
- Source data
- September 10, 2026
- Records indexed
- 84,001
- Screened
- Sep 17, 2026, 11:21 PM UTC
This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.
SAM.gov Exclusions
U.S. General Services Administration
SAM.gov Exclusions was not checked.
SAM.gov screening is not configured on this deployment. No SAM check has been performed.
- Screened
- Not checked
This is an NPI-based check only. NPISignal does not publish name-based exclusion matches on a provider profile. A shared or similar name is a lead that requires human review, not an identification, and this page is not the place to make one. Run a name-based screening below to see potential matches with the reasons for each.
This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.
Searches OIG LEIE and SAM.gov by name and reviews every potential match.
Specialties & Taxonomies
- Primary
General Practice
Allopathic & Osteopathic Physicians
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
Taxonomy code 208D00000X Military Health Care Provider
Other Service Providers
Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.
Taxonomy code 171000000XStudent in an Organized Health Care Education/Training Program
Student, Health Care
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
Taxonomy code 390200000X
Provider-Reported License Information
- General Practice (Virginia)
- 0101286704
Practice Locations
Practice Location
620 John Paul Jones Cir
Portsmouth, Virginia 23708-2111
Phone: (757) 953-0669
Record Information
- Enumeration Date
- March 19, 2024
- Provider's NPPES Record Last Updated
- September 26, 2025
- Certification Date
- September 26, 2025
- NPISignal NPPES Dataset
- August 2026
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