Individual
CONSTANCE G. NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655
(508) 421-1400
(508) 421-1490
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
55749
MA
2083C0008X
Clinical Informatics Physician
55749
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110042960A
—
MA
Enumeration date
12/07/2005
Last updated
05/17/2018
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