Individual
JOHN D NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
GLACIER CREEK OFFICE PARK- BLDG II, 6711 TOWPATH RD., SUITE 175, EAST SYRACUSE, NY 13057-9510
(315) 458-2211
(315) 452-9025
Mailing address
GLACIER CREEK OFFICE PARK- BLDG II, 6711 TOWPATH RD., SUITE 175, EAST SYRACUSE, NY 13057-9510
(315) 458-2211
(315) 452-9025
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
133705
NY
208C00000X
Colon & Rectal Surgery Physician
Primary
133705
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00456919
—
NY
Enumeration date
09/19/2006
Last updated
12/13/2023
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