Basic Information
| Provider Information | |||||||||
| NPI: | 1184706913 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NICHOLSON-UHL | ||||||||
| FirstName: | CLIFTON | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26 CASTLE PINES DR | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701313326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043496945 | ||||||||
| FaxNumber: | 5043496949 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 MEDICAL CENTER BLVD | ||||||||
| Address2: | SUITE 250S | ||||||||
| City: | MARRERO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700723151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043496945 | ||||||||
| FaxNumber: | 5043496949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 02/19/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD.021994 | LA | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 07-00454 | 01 | LA | UNITED HEALTHCARE | OTHER | 1669954 | 05 | LA | MEDICAID | 5405145002 | 01 | LA | CIGNA | OTHER | 5498645 | 01 | LA | AETNA | OTHER |