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NPI Code Detail

MEDICARE: DR. DAVID C. NICHOLS PH.D.

MEDICARE: DR. DAVID C. NICHOLS PH.D.
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
1103TC0700XClinical Psychologist605NH

General Provider Information

NPI Number : 1689781247
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID C. NICHOLS PH.D.
Provider Business Mailing Address
First Line : 28 DRAKE LN
Second Line :
City : SCARBOROUGH
State : ME
Zip : 04074-7414
Country : US
Telephone Number : 207-858-2961
Fax Number : 603-679-2048
Provider Business Practice Location Address
First Line : 345 COTTAGE RD
Second Line :
City : SOUTH PORTLAND
State : ME
Zip : 04106-3919
Country : US
Telephone Number : 207-858-2961
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2006
Last Update Date : 02/24/2016

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