Provider Demographics
NPI:1639250145
Name:NICHOLSON, DAVID SCOTT (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SCOTT
Last Name:NICHOLSON
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 1:4403 STATE ROUTE 725 STE A1
Mailing Address - Street 2:
Mailing Address - City:BELLBROOK
Mailing Address - State:OH
Mailing Address - Zip Code:45305-2700
Mailing Address - Country:US
Mailing Address - Phone:937-310-1218
Mailing Address - Fax:937-310-1378
Practice Address - Street 1:4403 STATE ROUTE 725 STE A1
Practice Address - Street 2:
Practice Address - City:BELLBROOK
Practice Address - State:OH
Practice Address - Zip Code:45305
Practice Address - Country:US
Practice Address - Phone:937-310-1218
Practice Address - Fax:937-310-1378
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008874207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2701213Medicaid
OH2701213Medicaid
OHNI4196311Medicare ID - Type Unspecified