Provider Demographics
NPI:1790983237
Name:NICHOLS, BENJAMIN JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JOSEPH
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1300 S ELISEO DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2023
Mailing Address - Country:US
Mailing Address - Phone:415-925-0550
Mailing Address - Fax:415-925-9062
Practice Address - Street 1:1300 S ELISEO DR
Practice Address - Street 2:SUITE 207
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2023
Practice Address - Country:US
Practice Address - Phone:415-925-0550
Practice Address - Fax:415-925-9062
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA97389207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology