MEDICARE: NICHOLAS HILARY FORDE 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	207Q00000X	Family Medicine Physician	G79972	CA

General Provider Information

NPI Number	:	1821023862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS HILARY FORDE MD

Provider Business Mailing Address
First Line	:	1500 EXPO PKWY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-4227
Country	:	US
Telephone Number	:	916-469-4690
Fax Number	:	916-563-7229

Provider Business Practice Location Address
First Line	:	4241 FLORIN RD STE 240
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-2535
Country	:	US
Telephone Number	:	916-737-5555
Fax Number	:	916-391-2291

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	04/26/2024

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