Provider Demographics
NPI:1013962026
Name:MCNICHOLAS, JUDITH A (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:MCNICHOLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:630 PLANTATION STREET
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-871-0700
Mailing Address - Fax:508-616-4411
Practice Address - Street 1:900 UNION ST
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-5408
Practice Address - Country:US
Practice Address - Phone:508-871-0700
Practice Address - Fax:508-616-4411
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76652207VF0040X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1060988OtherFIRST HEALTH
042472266OtherPRIVATE HEALTHCARE SYSTEM
J13545OtherBLUE CARE ELECT
J13545OtherBLUE SHIELD INDEMNITY
042472266OtherUNITED HEALTHCARE
042472266OtherTRICARE CHAMPUS
5070604OtherAETNA US HEALTHCARE
J13545OtherBLUE SHIELD HMO BLUE
042472266OtherONE HEALTH PLAN
MA110052917AMedicaid
406954OtherTUFTS HEALTH PLAN
784221OtherMVP HEALTH CARE
042472266OtherTHREE RIVERS
28030OtherHEALTHY START
3212073OtherCIGNA HEALTH PLAN
9901002OtherFALLON COMMUNITY HEALTH
28030OtherCHILDRENS MED SECURITY
AA6366OtherHARVARD PILGRIM HLTHCARE
5070604OtherAETNA US HEALTHCARE
MAJ13545Medicare ID - Type Unspecified