Provider Demographics
NPI:1588632020
Name:NICHOLS, KATHERINE VIRGINIA (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:VIRGINIA
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 MCCONVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-4536
Mailing Address - Country:US
Mailing Address - Phone:434-237-8886
Mailing Address - Fax:434-239-6807
Practice Address - Street 1:1212 MCCONVILLE ROAD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4536
Practice Address - Country:US
Practice Address - Phone:434-237-8886
Practice Address - Fax:434-239-6807
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047218208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics