Provider Demographics
NPI:1316991631
Name:NICHOLS, DAVID GREGORY (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:GREGORY
Last Name:NICHOLS
Suffix:
Gender:M
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 64382
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4382
Mailing Address - Country:US
Mailing Address - Phone:410-933-5474
Mailing Address - Fax:
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-933-5474
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD30317207L00000X, 208VP0014X
MDD72023207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Not Answered207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Not Answered208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDMQ83Medicare ID - Type UnspecifiedINDIVIDUAL
MDMP81Medicare ID - Type UnspecifiedINDIVIDUAL
MDMQ16Medicare ID - Type UnspecifiedINDIVIDUAL
MDKR76JHMedicare ID - Type UnspecifiedGROUP
MDD72023Medicare UPIN
MDKR78JHMedicare ID - Type UnspecifiedGROUP
MDKR79JHMedicare ID - Type UnspecifiedGROUP