Provider Demographics
NPI:1396778213
Name:NICHOLSON, PHILIP GEOFFREY JR (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:GEOFFREY
Last Name:NICHOLSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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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:717-851-4005
Mailing Address - Fax:717-812-2495
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-4005
Practice Address - Fax:717-812-2495
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418596208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2161248OtherMAMSI-WMG
PA001879036Medicaid
PA1525786OtherGATEWAY
MD616204OtherCAREFIRST MD BCBS
PA03124401OtherCAPITAL BLUE CROSS-WMG
PA7873488OtherAETNA
PA1382427OtherHIGHMARK BLUE SHIELD
PA79007OtherGEISINGER
PA15999OtherJOHNS HOPKINS
PA20090446OtherAMERIHEALTH MERCY-WMG
PA126511OtherUNISON-WMG
PA2073748000OtherAMERIHEALTH 65 PA
PA110234126Medicare PIN
PA79007OtherGEISINGER
PA054899FLTMedicare PIN