MEDICARE: HAROLD R NICOLETTE, DO, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0165	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043478142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAROLD R NICOLETTE, DO, PA

Provider Business Mailing Address
First Line	:	6 CARRIAGE LN
Second Line	:	SUITE B
City	:	CHARLESTON
State	:	SC
Zip	:	29407-6010
Country	:	US
Telephone Number	:	843-766-4100
Fax Number	:	843-571-4177

Provider Business Practice Location Address
First Line	:	6 CARRIAGE LN
Second Line	:	SUITE B
City	:	CHARLESTON
State	:	SC
Zip	:	29407-6010
Country	:	US
Telephone Number	:	843-766-4100
Fax Number	:	843-571-4177

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HAROLD ROY NICOLETTE
Credential	:	D.O.
Telephone Number	:	843-766-4100

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	05/27/2008

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