Provider Demographics
NPI:1952342420
Name:NICHOLSON, JAMES JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOSEPH
Last Name:NICHOLSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:JOSEPH
Other - Last Name:NICHOLSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:103 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1712
Mailing Address - Country:US
Mailing Address - Phone:610-828-6990
Mailing Address - Fax:610-828-7364
Practice Address - Street 1:103 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1712
Practice Address - Country:US
Practice Address - Phone:610-828-6990
Practice Address - Fax:610-828-7364
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS00279OL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0719029Medicaid
PAD98603Medicare UPIN
PA0719029Medicaid