Individual
WALTER JAY NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
30 MONUMENT RD, SUITE 1100, YORK, PA 17403-5024
(717) 851-2441
(717) 260-3322
Mailing address
3421 CONCORD RD, YORK, PA 17402-9001
(717) 851-2441
(717) 260-3322
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
MD017640E
PA
207RI0011X
Interventional Cardiology Physician
Primary
MD017640E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000696514
—
PA
01
—
0156924
HIGHMARK BLUE SHIELD
PA
01
—
01660801
CAPITAL BLUE CROSS
PA
01
—
060013259
RAILROAD MEDICARE PIN
PA
Enumeration date
06/03/2006
Last updated
09/26/2022
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