Provider Demographics
NPI:1689054165
Name:NICHOLAS, JILIAN (DO)
Entity Type:Individual
Prefix:
First Name:JILIAN
Middle Name:
Last Name:NICHOLAS
Suffix:
Gender:F
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:PO BOX 412752 APT G8
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8800
Mailing Address - Country:US
Mailing Address - Phone:443-481-3356
Mailing Address - Fax:
Practice Address - Street 1:2000 MEDICAL PKWY STE 600
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3748
Practice Address - Country:US
Practice Address - Phone:443-924-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH91741208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery