MEDICARE: DR. JOHN CHARLES NICHOLSON 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	207Y00000X	Otolaryngology Physician	J0160	TX

General Provider Information

NPI Number	:	1790787984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN CHARLES NICHOLSON M.D.

Provider Business Mailing Address
First Line	:	NAVAL HOSPITAL, ATTN: PROFESSIONAL AFFAIRS (CODE 083F)
Second Line	:	ONE BOONE ROAD
City	:	BREMERTON
State	:	WA
Zip	:	98312-1898
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 BOONE RD
Second Line	:	NAVAL HOSPITAL
City	:	BREMERTON
State	:	WA
Zip	:	98312-1894
Country	:	US
Telephone Number	:	360-475-4426
Fax Number	:

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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