MEDICARE: DIANNE W. NICHOLAS M.D., PA

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	207R00000X	Internal Medicine Physician	J2238	TX

General Provider Information

NPI Number	:	1821263468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIANNE W. NICHOLAS M.D., PA

Provider Business Mailing Address
First Line	:	PO BOX 14231
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77221-4231
Country	:	US
Telephone Number	:	713-440-0602
Fax Number	:	713-944-8903

Provider Business Practice Location Address
First Line	:	5160 TIMBER CREEK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77017-5968
Country	:	US
Telephone Number	:	713-440-0602
Fax Number	:	713-944-8903

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DIANNE NICHOLAS
Credential	:	MD
Telephone Number	:	713-440-0602

Provider Enumeration Date	:	04/24/2008
Last Update Date	:	08/28/2009

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