Provider Demographics
NPI:1942427042
Name:NICHOLAS, KAROLYN (MD)
Entity Type:Individual
Prefix:
First Name:KAROLYN
Middle Name:
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAROLYN
Other - Middle Name:
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:417 STATE ST
Mailing Address - Street 2:STE 439
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6630
Mailing Address - Country:US
Mailing Address - Phone:207-941-8200
Mailing Address - Fax:207-990-4848
Practice Address - Street 1:417 STATE ST
Practice Address - Street 2:STE 439
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6630
Practice Address - Country:US
Practice Address - Phone:207-941-8200
Practice Address - Fax:207-990-4848
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1942427042Medicaid