Healthcare Provider Details

I. General information

NPI: 1801883327
Provider Name (Legal Business Name): KATHRYN ANNE NICHOLSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN A TUOHY M.D.

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 CONNOLLY DR
RED LION PA
17356-9427
US

IV. Provider business mailing address

713 CONNOLLY DR
RED LION PA
17356-9427
US

V. Phone/Fax

Practice location:
  • Phone: 851-851-6040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD428322
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD428322
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: