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DR. MATTHEW NICHOLS

>> Family Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1093028052

Individual Registrant:
DR. MATTHEW  NICHOLS 
Gender: M
Not Sole Proprietor

Location and contact information for practice:
270 MAIN ST  PORTLAND, CT 06480-1859 US
Tel: 860-342-3392  Fax: 860-358-8658

Contact information for business:
28 CRESCENT ST  MIDDLETOWN, CT 06457-3654 US
Tel: 860-358-4820  Fax: 860-358-8661

Registration Information:
NPI: 1093028052
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207Q00000XAllopathic & Osteopathic Physicians
Family Medicine
CT051299

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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