Provider Demographics
NPI:1821026451
Name:NICHOLS, GINA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
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 1:38 E COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-2316
Mailing Address - Country:US
Mailing Address - Phone:614-834-7030
Mailing Address - Fax:614-834-7031
Practice Address - Street 1:38 E COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-2316
Practice Address - Country:US
Practice Address - Phone:614-834-7030
Practice Address - Fax:614-834-7031
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.086704207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0114511OtherUNITED HEALTHCARE OF OHIO
OH2611267Medicaid
OH000000377623OtherANTHEM BC/BS
OHNI4177191Medicare ID - Type Unspecified
OH2611267Medicaid