Individual
DR. MARIO E NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6525 BELCREST ROAD, SUITE 160, HYATTSVILLE, MD 20782-2016
(301) 209-6155
(301) 209-6206
Mailing address
2101 EAST JEFFERSON STREET, PPQA MEDICARE COMPLIANCE UNITE 4 WEST KAISER PERMANENTE, ROCKVILLE, MD 20852-4908
(301) 816-6660
(301) 816-6308
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D41747
MD
207R00000X
Internal Medicine Physician
MD21652
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182511900
—
MD
Enumeration date
12/12/2006
Last updated
01/22/2025
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