1164411344 NPI number — THOMAS D NICHOLAS MD DANIEL J DWYER MD

Table of content: (NPI 1164411344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164411344 NPI number — THOMAS D NICHOLAS MD DANIEL J DWYER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS D NICHOLAS MD DANIEL J DWYER MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164411344
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 W HIGH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47872-1735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-569-2057
Provider Business Mailing Address Fax Number:
765-569-2340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 W HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47872-1735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-569-2057
Provider Business Practice Location Address Fax Number:
765-569-2340
Provider Enumeration Date:
10/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DWYER
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
765-569-2057

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CD8603 . This is a "RR MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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