1942427042 NPI number — KAROLYN NICHOLAS MD

Table of content: KAROLYN NICHOLAS MD (NPI 1942427042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942427042 NPI number — KAROLYN NICHOLAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NICHOLAS
Provider First Name:
KAROLYN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BELL
Provider Other First Name:
KAROLYN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942427042
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
417 STATE ST
Provider Second Line Business Mailing Address:
STE 439
Provider Business Mailing Address City Name:
BANGOR
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04401-6630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-941-8200
Provider Business Mailing Address Fax Number:
207-990-4848

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
417 STATE ST
Provider Second Line Business Practice Location Address:
STE 439
Provider Business Practice Location Address City Name:
BANGOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04401-6630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-941-8200
Provider Business Practice Location Address Fax Number:
207-990-4848
Provider Enumeration Date:
04/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  1 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1942427042 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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