Individual
GARY L NICHOLSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3120 GOVERNORS PLACE BLVD, KETTERING, OH 45409-1328
(937) 293-1622
Mailing address
2264 BERRYCREEK DR, KETTERING, OH 45440-2621
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
35034705
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0330270
—
OH
Enumeration date
05/11/2006
Last updated
07/09/2007
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