Individual
MR. PHILLIP TODD NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 DONNALLY ST, SUITE 200, CHARLESTON, WV 25301-1648
(304) 342-0124
(304) 340-2204
Mailing address
PO BOX 1628, CHARLESTON, WV 25326-1628
(304) 342-0124
(304) 340-2204
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
0101273372
VA
207Y00000X
Otolaryngology Physician
19053
WV
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
0101273372
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0300079000
—
WV
01
—
040014129
RR MEDICARE
WV
01
—
1157768001
CIGNA
WV
01
—
550595497023
BC/BS
WV
01
—
7979026
AETNA
WV
Enumeration date
07/19/2005
Last updated
05/28/2024
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