Basic Information
| Provider Information | |||||||||
| NPI: | 1689054165 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NICHOLAS | ||||||||
| FirstName: | JILIAN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 412752 APT G8 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022418800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434813356 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2000 MEDICAL PKWY STE 600 | ||||||||
| Address2: | |||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214013748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439242900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2015 | ||||||||
| LastUpdateDate: | 05/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | H91741 | MD | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.