Healthcare Provider Details

I. General information

NPI: 1396903761
Provider Name (Legal Business Name): ELIZABETH MAY NICHOLS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2008
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 CHARTER DR SUITE G030
COLUMBIA MD
21044-3128
US

IV. Provider business mailing address

PO BOX 64620
BALTIMORE MD
21264-4620
US

V. Phone/Fax

Practice location:
  • Phone: 443-546-1300
  • Fax:
Mailing address:
  • Phone: 410-328-6080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberD75554
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: