Provider Demographics
NPI:1285619569
Name:NICHOLS, VIRGINIA GUEST (MD)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:GUEST
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:316 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1113
Practice Address - Country:US
Practice Address - Phone:843-402-1638
Practice Address - Fax:843-402-1703
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC313442080N0001X
SCTL330942080N0001X
SC330942080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ31344Medicaid
VA6101895Medicaid
WV3000364000Medicaid
5641221OtherAETNA
NC28712OtherMEDCOST
NC8939OtherPARTNERS
NC62542OtherBCBS
NC8962542Medicaid
NC8962542Medicaid
NC8939OtherPARTNERS
SCQ31344Medicaid
VA6101895Medicaid