Individual
KEITH ANDREW NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
130 TEMPLE ST, SUITE 100, OWEGO, NY 13827-1421
(607) 687-5616
(607) 687-5989
Mailing address
130 TEMPLE ST, SUITE 100, OWEGO, NY 13827-1421
(607) 687-5616
(607) 687-5989
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
141416
NY
Other
Enumeration date
01/25/2006
Last updated
10/08/2007
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