Provider Demographics
NPI:1700816360
Name:NICHOLS, RHONDA R (MD)
Entity Type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:R
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 1:151 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102
Mailing Address - Country:US
Mailing Address - Phone:973-622-3900
Mailing Address - Fax:973-622-1698
Practice Address - Street 1:151 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-3026
Practice Address - Country:US
Practice Address - Phone:973-622-3900
Practice Address - Fax:973-622-1698
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03769900207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1559800Medicaid