Provider Demographics
NPI:1376520643
Name:NICHOLAS, DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:NICHOLAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 HAL GREER BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3804
Mailing Address - Country:US
Mailing Address - Phone:304-526-2200
Mailing Address - Fax:304-399-1507
Practice Address - Street 1:1340 HAL GREER BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3804
Practice Address - Country:US
Practice Address - Phone:304-526-2200
Practice Address - Fax:304-399-1507
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1452207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2072386Medicaid
KY64942931Medicaid
AL1376520643Medicaid
WV1045606OtherWV DWC
WV1376520643Medicaid
WV000857496OtherWV BCBS
TNQ054110Medicaid
WVWV0524AOtherMEDICARE FOR CHHI
WV0788355Medicare PIN
WV0788356Medicare PIN