Provider Demographics
NPI:1184706913
Name:NICHOLSON-UHL, CLIFTON SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:CLIFTON
Middle Name:SCOTT
Last Name:NICHOLSON-UHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 CASTLE PINES DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-3326
Mailing Address - Country:US
Mailing Address - Phone:504-349-6945
Mailing Address - Fax:504-349-6949
Practice Address - Street 1:1111 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 250S
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3151
Practice Address - Country:US
Practice Address - Phone:504-349-6945
Practice Address - Fax:504-349-6949
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.021994174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA07-00454OtherUNITED HEALTHCARE
LA1669954Medicaid
LA5405145002OtherCIGNA
LA5498645OtherAETNA
LA5405145002OtherCIGNA
LA5W519 CB37Medicare PIN