Healthcare Provider Details

I. General information

NPI: 1912439019
Provider Name (Legal Business Name): DARRIN EARL NICHOLS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MACCORKLE AVE SE ROBERT C. BYRD CLINICAL TEACHING CENTER, 5TH FLOOR
CHARLESTON WV
25304-1227
US

IV. Provider business mailing address

483 COURT ST
ELIZABETH WV
26143-1109
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-4600
  • Fax: 304-388-4621
Mailing address:
  • Phone: 304-388-4600
  • Fax: 304-388-4621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29648
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: