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NPI Code Detail

MEDICARE: DR. MARK HOWARD NICHOLSON MD

MEDICARE: DR. MARK HOWARD NICHOLSON MD
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
12084P0800XPsychiatry Physician7623MT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
198195OTHERMTBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1235126566
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK HOWARD NICHOLSON MD
Provider Business Mailing Address
First Line : PO BOX 2315
Second Line :
City : BILLINGS
State : MT
Zip : 59103-2315
Country : US
Telephone Number : 406-245-1559
Fax Number : 406-564-1313
Provider Business Practice Location Address
First Line : 1018 N 30TH ST
Second Line :
City : BILLINGS
State : MT
Zip : 59101-0732
Country : US
Telephone Number : 406-245-1559
Fax Number : 406-564-1313
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2005
Last Update Date : 02/22/2016

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