Individual
DR. PETER D NICHOLAS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2760 CENTURY BLVD, WYOMISSING, PA 19610-3359
(610) 375-4251
(610) 375-6210
Mailing address
2760 CENTURY BLVD, WYOMISSING, PA 19610-3359
(610) 375-4251
(610) 375-6210
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD021072E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006369910001
—
PA
01
—
1730185505
NPI
PA
Enumeration date
06/24/2005
Last updated
07/06/2010
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