Provider Demographics
NPI:1326139353
Name:MCNICHOLAS, KATRHLEEN WINIFRED (MD)
Entity Type:Individual
Prefix:DR
First Name:KATRHLEEN
Middle Name:WINIFRED
Last Name:MCNICHOLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 30170
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-7170
Mailing Address - Country:US
Mailing Address - Phone:302-623-7150
Mailing Address - Fax:302-623-7374
Practice Address - Street 1:4755 OGLETOWN STANTON RD
Practice Address - Street 2:1E50
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-0002
Practice Address - Country:US
Practice Address - Phone:302-733-1980
Practice Address - Fax:302-733-1986
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC10005602208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000090001Medicaid
DE0000090001Medicaid
DEB41454Medicare UPIN