Provider Demographics
NPI:1649270133
Name:NICHOLS, ROBERT V (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:V
Last Name:NICHOLS
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 1:1905 GLEN MEADE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6024
Mailing Address - Country:US
Mailing Address - Phone:910-763-6251
Mailing Address - Fax:910-763-7408
Practice Address - Street 1:1905 GLEN MEADE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6024
Practice Address - Country:US
Practice Address - Phone:910-763-6251
Practice Address - Fax:910-763-7408
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30567174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8962545Medicaid
NC8962545Medicaid
NC2716696Medicare ID - Type Unspecified