Individual
DR. GLENN W NICHOLS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 MEDICAL PKWY, SUITE 111, CHESAPEAKE, VA 23320-4911
(757) 547-9301
(757) 548-9263
Mailing address
200 MEDICAL PKWY, SUITE 111, CHESAPEAKE, VA 23320-4911
(757) 547-9301
(757) 548-9263
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101036679
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140351
BLUE CROSS BLUE SHIELD
VA
Enumeration date
03/09/2006
Last updated
07/08/2007
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