Keith Andrew Nichols, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

141416 Issued in NY

Practice address

130 Temple St
Suite 100
Owego, NY 13827-1421

Phone

(607) 687-5616

Fax

(607) 687-5989

NPI assigned

Jan 25, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191801600000",
    "number": "1124098785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 TEMPLE ST",
            "address_2": "SUITE 100",
            "city": "OWEGO",
            "state": "NY",
            "postal_code": "138271421",
            "telephone_number": "607-687-5616",
            "fax_number": "607-687-5989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 TEMPLE ST",
            "address_2": "SUITE 100",
            "city": "OWEGO",
            "state": "NY",
            "postal_code": "138271421",
            "telephone_number": "607-687-5616",
            "fax_number": "607-687-5989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "KEITH",
        "middle_name": "ANDREW",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-25",
        "last_updated": "2007-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "141416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meghan E Morse
• Denise Lynn Moyer, CNM
• Jesse Natishak
• Laurel J Neira, MS CF-SLP
• Lisa Newman, DO
• Andrew Justen Nielsen, PHARMD
• John T. Novick, CASAC
• NP in Family Health on Call PLLC
• Andrea Gaile Ochoa, RPA
• Christina Marie Olevano, BSPTA

• Family Medicine Physician in Owego, NY
• Providers in Owego, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.