Doctor Name: | DR. GLENN W NICHOLS |
NPI Number: | 1831167675 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 0101036679 |
Business Practice Address: | 200 Medical Pkwy Suite 111 Chesapeake, VA - 233204911 |
Business Phone Number: | 7575479301 |
Business Fax Number: | 7575489263 |
Mailing Address: | 200 Medical Pkwy, Suite 111 CHESAPEAKE |
State: | VA |
Postal Code: | 233204911 |
Phone Number: | 7575479301 |
Fax Number: | 7575489263 |
NPI Enumeration Date: | 03/09/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 0101036679 |
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. |