Healthcare Provider Details

I. General information

NPI: 1689065021
Provider Name (Legal Business Name): NORMAN GREELEY NICOLSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST DEPT OF
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

600 N WOLFE ST DEPARTMENT OF SURGERY, BLALOCK 6
BALTIMORE MD
21287
US

V. Phone/Fax

Practice location:
  • Phone: 410-502-2846
  • Fax:
Mailing address:
  • Phone: 410-502-2846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberD0101121
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: