MEDICARE: DR. DAVID NICHOLAS DO

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	1452	WV

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	WV0524A	OTHER	WV	MEDICARE FOR CHHI

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1045606	OTHER	WV	WV DWC
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	000857496	OTHER	WV	WV BCBS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1376520643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID NICHOLAS DO

Provider Business Mailing Address
First Line	:	1340 HAL GREER BLVD
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-3804
Country	:	US
Telephone Number	:	304-526-2200
Fax Number	:	304-399-1507

Provider Business Practice Location Address
First Line	:	1340 HAL GREER BLVD
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-3804
Country	:	US
Telephone Number	:	304-526-2200
Fax Number	:	304-399-1507

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	04/13/2021

1340 HAL GREER BLVD STE 4000
HUNTINGTON, WV
25701-3804

Practice Phone: 304-691-1787
Practice Fax: 304-691-8711