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Individual

STEPHEN EDWIN NICOLSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1313 21ST AVE S, VANDERBILT UNIVERSITY MEDICAL CENTER, 1103 OXFORD HOUSE, NASHVILLE, TN 37232-0001
(615) 875-5838
Mailing address
1313 21ST AVE S, VANDERBILT UNIVERSITY MEDICAL CENTER, 1103 OXFORD HOUSE, NASHVILLE, TN 37232-0001
(615) 875-5838

Taxonomy

Speciality
Code
Description
License number
State
2084P0015X
Psychosomatic Medicine Physician
Primary
48549
TN
2084P0800X
Psychiatry Physician
054333
GA
2084P0800X
Psychiatry Physician
243838
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02896519
NY
05
2117096
MA
Enumeration date
01/10/2006
Last updated
09/05/2012
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