Individual
DR. THEODORE WILLIAM NICHOLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3210 N. CROATAN HWY., SUITE 3, KILL DEVIL HILLS, NC 27948
(252) 261-5868
(252) 441-7793
Mailing address
3210 N. CROATAN HWY., SUITE 3, KILL DEVIL HILLS, NC 27948
(252) 261-5868
(252) 441-7793
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
2002-00059
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
131G4
BC/BS NC PROVIDER NUMBER
NC
01
—
299811
UNITED PROVIDER NUMBER
NC
05
—
89131G4
—
NC
01
—
B8563
MEDCOST PROVIDER NUMBER
NC
Enumeration date
07/16/2006
Last updated
07/09/2010
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