Individual
BRUCE D. NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1259 S CEDAR CREST BLVD STE 317, ALLENTOWN, PA 18103
(610) 402-1757
(610) 402-9089
Mailing address
PO BOX 783311, PHILADELPHIA, PA 19178-3311
(484) 884-4500
(484) 884-0699
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
MD046894L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012842940
—
PA
01
—
01216902
CAP BLUE CROSS
PA
01
—
0432922-002
CIGNA
PA
01
—
0559065000
INDEP. BLUE CROSS
PA
01
—
0721766
KHP CENTRAL
PA
01
—
07721766
GATEWAY
PA
01
—
1234452
THREE RIVERS
PA
01
—
1284294
HIGHMARK
PA
01
—
20008174
AMERIHEALTH MERCY
PA
01
—
30000048
KEYSTONE MERCY
PA
01
—
815211
AETNA
PA
01
—
P2616744
OXFORD
PA
Enumeration date
10/06/2005
Last updated
12/28/2018
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