Provider Demographics
NPI:1578669453
Name:NICHOLS, KEITH R (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:R
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 PILLSBURY ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3556
Mailing Address - Country:US
Mailing Address - Phone:603-224-4776
Mailing Address - Fax:603-228-2113
Practice Address - Street 1:1 PILLSBURY ST
Practice Address - Street 2:SUITE 202
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3556
Practice Address - Country:US
Practice Address - Phone:603-224-4776
Practice Address - Fax:603-228-2113
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH9457207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0105334Y0NH01OtherANTHEM BCBS
NH10614OtherCIGNA
NH80003697Medicaid
NHE53922Medicare UPIN
NHRE3697Medicare ID - Type Unspecified