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General NPI Number Information
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NPI Number | 1396744652
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Entity Type | Individual
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Provider Name | PHILLIP TODD NICHOLS MD
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Gender | Male
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 500 DONNALLY ST SUITE 200
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City | CHARLESTON
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State | WV
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Zip | 25301-1648
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Country | US
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Telephone | 304-342-0124
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Fax | 304-340-2204
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Provider Business Mailing Address
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Address Line | PO BOX 1628
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City | CHARLESTON
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State | WV
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Zip | 25326-1628
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Country | US
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Telephone | 304-342-0124
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Fax | 304-340-2204
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 19053
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 0101273372
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 0101273372
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License Number State | VA
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