Individual
CHARLES HATHAWAY NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4420 LAKE BOONE TRL, RALEIGH, NC 27607-7505
(919) 784-3034
Mailing address
PO BOX 18139, RALEIGH, NC 27619-8139
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
30439
NC
208VP0014X
Interventional Pain Medicine Physician
30439
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
132EO
BCBS NC
NC
01
—
21504
PARTNERS
NC
01
—
57289
MEDCOST
NC
01
—
6715093
CIGNA
NC
05
—
89132EO
—
NC
Enumeration date
08/31/2006
Last updated
12/11/2007
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