MEDICARE: DR. ANDREW O NICHOLS 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
1	207R00000X	Internal Medicine Physician	72779	MA

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	:	1598762858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW O NICHOLS MD

Provider Business Mailing Address
First Line	:	57 BEDFORD ST
Second Line	:	STE 130
City	:	LEXINGTON
State	:	MA
Zip	:	02420-4500
Country	:	US
Telephone Number	:	781-862-7500
Fax Number	:	781-861-1409

Provider Business Practice Location Address
First Line	:	57 BEDFORD ST
Second Line	:	STE 130
City	:	LEXINGTON
State	:	MA
Zip	:	02420-4500
Country	:	US
Telephone Number	:	781-862-7500
Fax Number	:	781-861-1409

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

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	03/23/2009

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