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General NPI Number Information
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NPI Number | 1629145768
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Entity Type | Individual
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Provider Name | GARY J NICHOLSON MD
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Gender | Male
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 11/25/2020
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Provider Practice Location Address
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Address Line | 600 FITCH ST STE 102
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City | ELMIRA
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State | NY
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Zip | 14905-1634
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Country | US
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Telephone | 607-734-6544
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Fax | 607-734-6580
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Provider Business Mailing Address
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Address Line | 571 SAINT JOSEPHS BLVD FL 2
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City | ELMIRA
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State | NY
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Zip | 14901-3230
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Country | US
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Telephone | 607-271-2050
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Fax | 607-873-1244
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 196428
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License Number State | NY
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