Individual provider · NPI-1
Dr. Matthew Nichols
Family Medicine · Portland, CT
NPI number1093028052
StatusActive
Last updated in NPPESApr 11, 2017
Details
- NPI
- 1093028052
- Entity type
- Individual (NPI-1)
- Name
- Dr. Matthew Nichols
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 20, 2010
- Last updated
- Apr 11, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 051299 | CT | Yes |
Practice location
270 Main StPortland, CT 06480-1859
Phone 860-342-3392 · Fax 860-358-8658
Mailing address
28 Crescent StMiddletown, CT 06457-3654
Phone 860-358-4820 · Fax 860-358-8661
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