Healthcare Provider Details

I. General information

NPI: 1750499711
Provider Name (Legal Business Name): ERIKA L NICHELSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERIKA L TUDOR DO

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11089 RESORT RD STE 204
ELLICOTT CITY MD
21042-2073
US

IV. Provider business mailing address

11089 RESORT RD STE 204
ELLICOTT CITY MD
21042-2073
US

V. Phone/Fax

Practice location:
  • Phone: 410-696-3605
  • Fax:
Mailing address:
  • Phone: 410-696-3605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS021824
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberH0065550
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: