Provider Demographics
NPI:1033298138
Name:NICHOLSON, DOROTHY MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:MARY
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S WHITING ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-3418
Mailing Address - Country:US
Mailing Address - Phone:703-751-8804
Mailing Address - Fax:703-751-1218
Practice Address - Street 1:101 S WHITING ST
Practice Address - Street 2:SUITE 105
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3418
Practice Address - Country:US
Practice Address - Phone:703-751-8804
Practice Address - Fax:703-751-1218
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010137786207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5876257Medicaid
VA5876257Medicaid
00A712D30Medicare ID - Type Unspecified