Provider Demographics
NPI:1407081680
Name:NICHOLAS, AMY LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LYNN
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:NICHOLAS-HWANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5283 CORPORATE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-2879
Mailing Address - Country:US
Mailing Address - Phone:301-662-4545
Mailing Address - Fax:301-662-4044
Practice Address - Street 1:5283 CORPORATE DR STE 201
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-2879
Practice Address - Country:US
Practice Address - Phone:301-662-4545
Practice Address - Fax:301-662-4044
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101253214207W00000X, 207W00000X
MDD0075217207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology