| Doctor Name: | KEITH CAMERON NICHOLS |
| NPI Number: | 1538194766 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 01010406236 |
| Business Practice Address: | 1500 Breezeport Way Suite 100 Suffolk, VA - 234353727 |
| Business Phone Number: | 7576869747 |
| Business Fax Number: | 7576869748 |
| Mailing Address: | 397 Churchill Hubbard Rd, YOUNGSTOWN |
| State: | OH |
| Postal Code: | 445051375 |
| Phone Number: | 3307596750 |
| Fax Number: | 8666874439 |
| NPI Enumeration Date: | 07/12/2006 |
| NPI Last Update Date: | 02/19/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 01010406236 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |