Individual
MR. JOHN DAVID NICHOLSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
111 N 49TH ST, PHILADELPHIA, PA 19139-2718
(215) 471-2488
(215) 471-2897
Mailing address
111 N 49TH ST, PHILADELPHIA, PA 19139-2718
(215) 471-2488
(215) 471-2897
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA001440L
PA
Other
Enumeration date
10/20/2010
Last updated
10/20/2010
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