Provider Demographics
NPI:1366403057
Name:NICHOLAS, JOSEPH ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:NICHOLAS
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 1:1000 SOUTH AVE
Mailing Address - Street 2:BOX 58
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-2733
Mailing Address - Country:US
Mailing Address - Phone:585-341-6770
Mailing Address - Fax:585-341-8305
Practice Address - Street 1:1000 SOUTH AVE
Practice Address - Street 2:BOX 58
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-2733
Practice Address - Country:US
Practice Address - Phone:585-341-6770
Practice Address - Fax:585-341-8305
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219959207RH0002X, 2083P0901X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02669221Medicaid
NYMDJ201OtherPREFERRED CARE
NYIA0787Medicare ID - Type Unspecified
NYH42328Medicare UPIN