Provider Demographics
NPI:1801883327
Name:NICHOLSON, KATHRYN ANNE (MD)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ANNE
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:A
Other - Last Name:TUOHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:713 CONNOLLY DR
Mailing Address - Street 2:
Mailing Address - City:RED LION
Mailing Address - State:PA
Mailing Address - Zip Code:17356-9427
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:713 CONNOLLY DR
Practice Address - Street 2:
Practice Address - City:RED LION
Practice Address - State:PA
Practice Address - Zip Code:17356-9427
Practice Address - Country:US
Practice Address - Phone:851-851-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428322207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50059837OtherCAPITAL BC-WMG AHIM
PA7252574OtherAETNA
MD883811OtherCAREFIRST MD BCBS
PA203272OtherJOHNS HOPKINS
PA101606926Medicaid
PA1873066OtherHIGHMARK BLUE SHIELD
PA102479OtherGEISINGER HEALTH PLAN
PA2733014000OtherAMERIHEALTH 65(PA)
PA203272OtherJOHNS HOPKINS
PA101606926Medicaid
PAI13254Medicare UPIN