Provider Demographics
NPI:1093888745
Name:NICHOLSON, CHRISTOPHER S (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:S
Last Name:NICHOLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7702 E PARHAM RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4371
Mailing Address - Country:US
Mailing Address - Phone:804-346-2070
Mailing Address - Fax:804-346-5171
Practice Address - Street 1:7702 E PARHAM RD
Practice Address - Street 2:SUITE 106
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4371
Practice Address - Country:US
Practice Address - Phone:804-346-2070
Practice Address - Fax:804-346-5171
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047032207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1093888745Medicaid
VA110141722OtherRAILROAD MEDICARE
812341OtherAETNA
2500831OtherUNITED
VA006099289Medicaid
VA1093888745Medicaid
F71609Medicare UPIN
018237V97Medicare PIN