Provider Demographics
NPI:1982677233
Name:NICHOLS, FRED MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:MICHAEL
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-273-8835
Mailing Address - Fax:717-202-0100
Practice Address - Street 1:845 HELEN DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7493
Practice Address - Country:US
Practice Address - Phone:717-273-8835
Practice Address - Fax:717-202-0100
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB5813300207V00000X
PAFN7479430207V00000X
PAOS009392L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5185700Medicaid
NJF36487Medicare UPIN
NJ5185700Medicaid