Provider Demographics
NPI:1235126566
Name:NICHOLSON, MARK HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:HOWARD
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:PO BOX 2315
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59103-2315
Mailing Address - Country:US
Mailing Address - Phone:406-245-1559
Mailing Address - Fax:406-564-1313
Practice Address - Street 1:1018 N 30TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0732
Practice Address - Country:US
Practice Address - Phone:406-245-1559
Practice Address - Fax:406-564-1313
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT76232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT98195OtherBLUE CROSS BLUE SHIELD
000084239Medicare ID - Type Unspecified
MT98195OtherBLUE CROSS BLUE SHIELD
D07737Medicare UPIN