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General NPI Number Information
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NPI Number | 1780115261
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Entity Type | Individual
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Provider Name | LOWELL T. NICHOLSON MD
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Gender | Male
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Dates
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Enumeration Date | 03/25/2017
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 505 PARNASSUS AVE ROOM M-987
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City | SAN FRANCISCO
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State | CA
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Zip | 94143-2204
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Country | US
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Telephone | 415-476-1528
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 DIVISADERO ST FL 4
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City | SAN FRANCISCO
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State | CA
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Zip | 94115-3011
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 12441612-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A159922
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License Number State | CA
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