Basic Information
| Provider Information | |||||||||
| NPI: | 1770706400 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THOMAS D NICHOLAS MD DANIEL J DWYER MD | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ROCKVILLE TOWN SQUARE CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 W HIGH ST | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7655692057 | ||||||||
| FaxNumber: | 7655692340 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 W HIGH ST | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7655692057 | ||||||||
| FaxNumber: | 7655692340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 07/24/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DWYER | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 7655692057 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 15D0362127 | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.