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General NPI Number Information
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NPI Number | 1013962026
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Entity Type | Individual
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Provider Name | JUDITH A MCNICHOLAS MD
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Gender | Female
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 900 UNION ST
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City | WESTBOROUGH
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State | MA
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Zip | 01581-5408
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Country | US
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Telephone | 508-871-0700
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Fax | 508-616-4411
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Provider Business Mailing Address
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Address Line | 630 PLANTATION STREET
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City | WORCESTER
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State | MA
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Zip | 01605
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Country | US
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Telephone | 508-871-0700
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Fax | 508-616-4411
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number | 76652
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 76652
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License Number State | MA
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