Provider Demographics
NPI:1871585497
Name:NICHOLS, TRENT WILLIAM JR (MD)
Entity type:Individual
Prefix:
First Name:TRENT
Middle Name:WILLIAM
Last Name:NICHOLS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 CORNWALL RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7233
Mailing Address - Country:US
Mailing Address - Phone:717-270-4545
Mailing Address - Fax:717-270-9010
Practice Address - Street 1:1151 CORNWALL RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7233
Practice Address - Country:US
Practice Address - Phone:717-270-4545
Practice Address - Fax:717-270-9010
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD021152E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology