Provider Demographics
NPI:1750372546
Name:NICHOLS, MARKYIA (MD)
Entity type:Individual
Prefix:
First Name:MARKYIA
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
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:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-0040
Mailing Address - Country:US
Mailing Address - Phone:207-498-2359
Mailing Address - Fax:207-498-3947
Practice Address - Street 1:163 VAN BUREN RD
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-3567
Practice Address - Country:US
Practice Address - Phone:207-498-2359
Practice Address - Fax:207-498-3947
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD63010207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1688272OtherAETNA HMO
253271OtherKAISER
0008OtherCAREFIRST
116464OtherJOHNS HOPKINS HEALTHCARE
MD407512900Medicaid
64632404OtherCAREFIRST
7834705OtherAETNA PPO
MD407512900Medicaid
I33444Medicare PIN