DR. GARY E. NICHOLS (NPI# 1386612141) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386612141 |
| Entity Type | Individual |
| Full Name | DR. GARY E. NICHOLS |
| Credential | M.D. |
| Practice Address |
2855 Campus Dr #350 Plymouth MN 55441-2649 |
| Practice Telephone | 7635201200 |
| Practice Fax Number | 7635201201 |
| Mailing Telephone | 7635201200 |
| Mailing Fax Number | 7635201201 |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2011-09-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 27358 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 992008100 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528314713 | Gary W Nichols | Counselor | 5150 E Stop 11 Rd Ste 10, Indianapolis, IN 46237-8629 | 2012-07-25 |
| 1437140357 | Gary Dale Nichols | Physician Assistant | 16th Street, Ctmc, Bldg 885, Fort Leonard Wood, MO 65473 | 2005-10-31 |
| 1316936156 | Gary Glenn Nichols | Physician Assistant | 1404 Willow Ln, North Wilkesboro, NC 28659-3584 | 2005-10-14 |
| 1033201587 | Gary Nichols | Internal Medicine | 2455 Summerfield Rd, Santa Rosa, CA 95405 | 2006-09-29 |
| 1477580132 | Gary Lee Nichols | Social Worker | 3250 Zemke Ave, Tampa, FL 33621-5023 | 2006-06-27 |
| 1891781803 | Gary A Nichols | Family Medicine | 3 E Benjamin Dr, New Martinsville, WV 26155-2705 | 2005-09-26 |
| Street Address |
2855 CAMPUS DR #350 |
| City | PLYMOUTH |
| State | MN |
| Zip Code | 55441-2649 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639171820 | Terry W. Hood | Neurological Surgery | 2855 Campus Dr, Ste 570, Plymouth, MN 55441-2660 | 2005-06-01 |
| 1891309092 | Bridget Pauline Williams | Pharmacist | 2855 Campus Dr, Plymouth, MN 55441-2649 | 2020-09-04 |
| 1093277238 | Megan Hickenbottom | Social Worker | 2855 Campus Dr, Plymouth, MN 55441-2649 | 2019-04-05 |
| 1831670470 | Stephanie Michelle Walek | Pharmacist | 2855 Campus Dr, Plymouth, MN 55441-2649 | 2018-08-22 |
| 1821502154 | Michael Blake Jacob | Orthopaedic Surgery | 2855 Campus Dr, Plymouth, MN 55441-2649 | 2017-11-22 |
| 1457741092 | Narges Golgol | Physician Assistant | 2855 Campus Dr, Plymouth, MN 55441-2649 | 2015-02-04 |
| 1295131357 | Eva Gabriela Martinez | Physical Therapist | 2855 Campus Dr, Suite 650, Plymouth, MN 55441-2649 | 2014-11-17 |
| 1336495068 | Allina Health System | Clinic/Center | 2855 Campus Dr, Plymouth, MN 55441-2649 | 2012-07-31 |
| 1477828515 | Vedavathi Ramesh Bellamkonda-athmaram | Pediatrics | 2855 Campus Dr, #350, Plymouth, MN 55441-2649 | 2012-03-21 |
| 1568739043 | Allina Health System | Clinic/Center | 2855 Campus Dr, Plymouth, MN 55441-2649 | 2011-11-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689190019 | The Recovery Clinic LLC | Clinic/Center | 9800 Shelard Pkwy Ste 215, Plymouth, MN 55441 | 2017-08-17 |
| 1356887186 | Katherine Marlow Bell | Dentist | 2805 Campus Dr Ste 245, Plymouth, MN 55441 | 2017-01-18 |
| 1083069538 | Mercade Waldon | Home Health Aide | 3501 Xenium Lane, Plymouth, MN 55441 | 2016-05-03 |
| 1346645538 | Phs Westhealth, Inc | Skilled Nursing Facility | 2775 Campus Drive North, Plymouth, MN 55441 | 2014-10-30 |
| 1427453125 | Samuel David Fine | Pharmacist | 4070 Goldenrod Ln, Plymouth, MN 55441 | 2014-10-24 |
| 1548672538 | Scott Aaron Schmidt | Dentist | 2720 Annapolis Circle N, Suite A, Plymouth, MN 55441 | 2014-05-23 |
| 1831498633 | Comforide Transportation Services LLC | Non-emergency Medical Transport (VAN) | 9730 37th Pl N Suite 201, Plymouth, MN 55441 | 2011-03-18 |
| 1255669271 | Tammy Kae Mehlhaus | Physician Assistant | 2855 Campus Drive, Suite 570, Plymouth, MN 55441 | 2009-12-02 |
| 1164758199 | Stephen P. Boger, Dds, Pa | Dentist | 2720 Annapolis Circle, Suite A, Plymouth, MN 55441 | 2009-10-27 |
| 1093908360 | Endodontic Professionals Pa Plymouth Endodontics | Dentist | 3401 Hwy 169 N, Plymouth, MN 55441 | 2007-08-21 |
| Find all providers in zip 55441 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043709124 | Erica Wade Lundberg | Pediatrics | 4875 Cottonwood Ln N, Plymouth, MN 55442-2277 | 2018-05-04 |
| 1598160939 | Shama Ahuja | Pediatrics | 12459 White Tail Ct, Plymouth, MI 48170-2875 | 2014-10-28 |
| 1447492855 | Zarina S Norton | Pediatrics | 49906 Fuller Ct, Plymouth, MI 48170-2869 | 2009-03-31 |
| 1811023617 | Sarah Lacy | Pediatrics | 990 W Ann Arbor Trl Ste 210, Plymouth, MI 48170-6202 | 2007-02-26 |
| 1942309653 | Performance Pediatrics, LLC | Pediatrics | 23 Aldrin Rd, Plymouth, MA 02360-4803 | 2006-09-21 |
| 1295751543 | Virnaliza Cassidy | Pediatrics | 3 Village Grn N, Suite 321, Plymouth, MA 02360-8803 | 2006-07-13 |
| 1881652303 | Ann M Powers | Pediatrics | 110 Long Pond Rd Ste 211, Long Pond Pediatrics Osteopathy PC, Plymouth, MA 02360 | 2006-05-03 |
| 1144281072 | Nancy Crocker | Pediatrics | 71 Highland St, Plymouth, NH 03264-1233 | 2006-03-30 |
| 1891765665 | Heidi Sophia Gomes | Pediatrics | 139 Sandwich St, Plymouth, MA 02360 | 2006-01-25 |
| 1235123217 | Mary Alonzi | Pediatrics | 9365 N Haggerty Rd, Plymouth, MI 48170-4622 | 2005-09-07 |
| Find all providers in PLYMOUTH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.