# KEITH A NICHOLS MD, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346421211
- **Authorized official:** JANE E NICHOLS (BUSINESS MANAGER)
- **Authorized official phone:** (607) 687-5616

## Contact information

- **Practice address:** 130 TEMPLE ST, SUITE 100, OWEGO, NY 13827-1408
- **Practice address phone:** (607) 687-5616
- **Mailing address:** 130 TEMPLE ST, SUITE 100, OWEGO, NY 13827-1408
- **Mailing address phone:** (607) 687-5616

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 141416-1 | NY | Yes |

## Other

- **Enumeration date:** 11/20/2007
- **Last updated:** 11/20/2007