MEDICARE: DR. JOSEPH ANTHONY NICHOLAS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	219959	NY
2	2083P0901X	Public Health & General Preventive Medicine Physician	219959	NY
3	208M00000X	Hospitalist Physician	219959	NY
4	207R00000X	Internal Medicine Physician	219959	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MDJ201	OTHER	NY	PREFERRED CARE

General Provider Information

NPI Number	:	1366403057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH ANTHONY NICHOLAS M.D.

Provider Business Mailing Address
First Line	:	1000 SOUTH AVE
Second Line	:	BOX 58
City	:	ROCHESTER
State	:	NY
Zip	:	14620-2733
Country	:	US
Telephone Number	:	585-341-6770
Fax Number	:	585-341-8305

Provider Business Practice Location Address
First Line	:	1000 SOUTH AVE
Second Line	:	BOX 58
City	:	ROCHESTER
State	:	NY
Zip	:	14620-2733
Country	:	US
Telephone Number	:	585-341-6770
Fax Number	:	585-341-8305

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	07/05/2023

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Directions to “ DR. JOSEPH ANTHONY NICHOLAS M.D.” Practice Location

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