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General NPI Number Information
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NPI Number | 1093004400
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Entity Type | Individual
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Provider Name | KATHRYN CANNADA NICHOLAS M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/06/2011
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Last Update Date | 04/17/2017
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Provider Practice Location Address
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Address Line | 600 N WOLFE ST NELSON 143
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City | BALTIMORE
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State | MD
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Zip | 21287-0005
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Country | US
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Telephone | 410-955-4567
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Fax |
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Provider Business Mailing Address
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Address Line | 600 N WOLFE ST NELSON 143
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City | BALTIMORE
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State | MD
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Zip | 21287-0005
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Country | US
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Telephone |
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 24892
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | D76167
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License Number State | MD
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