Provider Demographics
NPI:1598762858
Name:NICHOLS, ANDREW O (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:O
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 BEDFORD ST
Mailing Address - Street 2:STE 130
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4500
Mailing Address - Country:US
Mailing Address - Phone:781-862-7500
Mailing Address - Fax:781-861-1409
Practice Address - Street 1:57 BEDFORD ST
Practice Address - Street 2:STE 130
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4500
Practice Address - Country:US
Practice Address - Phone:781-862-7500
Practice Address - Fax:781-861-1409
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72779207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3074439Medicaid
MAJ11193Medicare ID - Type Unspecified
MAE86489Medicare UPIN