NICHOLAS CARROLL DESTEFANO MD
NPI 1154776755
General Practice in Fort Gordon, GA

Q: What is Nicholas Destefano's NPI number?

The NPI number for Nicholas Destefano is 1154776755. It was assigned to this individual provider in the NPPES registry on May 2, 2016.

Q: What is Nicholas Destefano's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Active since May 02, 2016PECOS EnrolledAccepts Medicare Assignment

300 E HOSPITAL RD, FORT GORDON, GA 30905(706) 383-5299 Get Directions Write a Review

NPPES record last updated: December 10, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Dec 10, 2025, Jul 15, 2021, Feb 11, 2019 (3 updates tracked since 2019).

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About Nicholas Carroll Destefano Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICHOLAS CARROLL DESTEFANO MD (NPI 1154776755) is an individual general practice provider in Fort Gordon, Georgia, licensed in Nebraska (30177) and active in the NPI registry since May 2016. He is enrolled in Medicare PECOS, maintains 14 additional practice locations, and is a graduate of Wayne State University School Of Medicine (2016).

NPPES Registry Identity

NPI1154776755

Entity TypeIndividualMale

Primary Taxonomy208D00000X

Provider Legal NameNICHOLAS CARROLL DESTEFANOCredential: MD

Location Address300 E HOSPITAL RDFort Gordon, GA 30905

Mailing Address300 E Hospital RdFort Gordon, GA 30905 · (706) 383-5299

Phone(706) 383-5299

Sole ProprietorNo

Medical School CMSWayne State University School Of MedicineGraduated 2016

Enumeration DateMay 2, 2016

Last NPPES UpdateDecember 10, 20253 updates tracked since enumeration

NPPES CertifiedDecember 10, 2025

✔ NPI 1154776755 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians

Taxonomy Code208D00000X

License✔ Licensed in NE · 30177

Definition

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

Also ListedFamily MedicineTaxonomy 207Q00000X · License C1-0028577 (DE)

300 E HOSPITAL RD, Fort Gordon, GA 30905

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Secondary Practice Locations 14

Location 132050 Long Neck RdMillsboro, DE 19966-6228 · Phone (302) 645-3150 · Fax (833) 908-2232

Location 2424 Savannah RdLewes, DE 19958-1462 · Phone (302) 645-3150 · Fax (833) 908-2232

Location 312100 Black Swan Dr Ste 104Lewes, DE 19958-4991 · Phone (302) 645-1315 · Fax (302) 644-2739

Location 417388 N Village Main Blvd Unit 21Lewes, DE 19958-7240 · Phone (302) 291-6050 · Fax (833) 450-5311

Location 521635 Biden Ave Unit 101Georgetown, DE 19947-4575 · Phone (302) 856-9596 · Fax (302) 645-4744

Location 6100 Silicato Pkwy Ste 201Milford, DE 19963-1273 · Phone (302) 393-2056 · Fax (302) 422-9359

Location 728538 DuPont Blvd Unit 1Millsboro, DE 19966-4791 · Phone (302) 829-3294 · Fax (833) 314-0538

Location 8232 Mitchell St Unit 301Millsboro, DE 19966-9412 · Phone (302) 316-4190 · Fax (302) 934-1207

Location 932550 Docs Pl Unit 2Millville, DE 19967-6975 · Phone (302) 539-4302 · Fax (302) 645-4766

Location 1023900 Milton Ellendale Hwy Ste 101Milton, DE 19968-2714 · Phone (302) 684-2033 · Fax (888) 987-4302

Location 1118947 John J Williams Hwy Unit 303Rehoboth Beach, DE 19971-4477 · Phone (302) 644-0690 · Fax (302) 644-0695

Location 1236450 Tidal Rd Unit 2Selbyville, DE 19975-4596 · Phone (302) 291-6045 · Fax (833) 449-3867

Location 131008 Kings HwyLewes, DE 19958-1932 · Phone (302) 291-6031 · Fax (833) 954-4028

Location 1436223 Farm Ln Ste 140Rehoboth Beach, DE 19971-1329 · Phone (302) 227-1268 · Fax (302) 227-1287

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Nicholas Carroll Destefano Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID446542229

PECOS Enrollment IDI20251219002133

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MATTHEW JAMES DELLEN MD

Student in an Organized Health Care Education/Training Program

300 E HOSPITAL RD
FORT GORDON, GA 30905

Richmond County (706) 787-5811

JAMES G PAIRMORE PA

Physician Assistant (Medical)

300 E HOSPITAL RD
FT. EISENHOWER, GA 30905

Richmond County (067) 787-0300

MISS AMRUTHA ELIZABETH MATHEW M.D.

Pediatrics

300 E HOSPITAL RD
FORT EISENHOWER, GA 30905

Richmond County (706) 787-9399

DR. WAQAS HAQ MD

Internal Medicine

300 E HOSPITAL RD
FORT GORDON, GA 30905

Richmond County (706) 787-5811

PETER YOON DDS

Dentist

300 E HOSPITAL RD
FORT EISENHOWER, GA 30905

Richmond County (706) 787-2516

SCOTT WALTON M.D.

Otolaryngology

300 E HOSPITAL RD
FT. GORDON, GA 30905

Richmond County (801) 400-5439

CHRISTOPHER BARRETT JONES M.D.

Emergency Medicine

300 E HOSPITAL RD
FORT EISENHOWER, GA 30905

Richmond County (706) 721-9289

AMANDA NICHOLE ELEY APRN, MSN, FNP-C

Nurse Practitioner (Family)

300 E HOSPITAL RD
FORT EISENHOWER, GA 30905

Richmond County (210) 473-8162

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nicholas Destefano's NPI number?

The NPI number for Nicholas Destefano is 1154776755. It was assigned to this individual provider in the NPPES registry on May 2, 2016.

Where is Nicholas Destefano located?

Nicholas Destefano practices at 300 E Hospital Rd, Fort Gordon, GA 30905. The listed phone number is (706) 383-5299.

What is Nicholas Destefano's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Is Nicholas Destefano enrolled in Medicare?

Yes. Nicholas Destefano is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Nicholas Destefano was last updated on December 10, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.