Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. John David Nicholson Jr., PA

Individual provider Physician Assistant · NPI 1790095933

Mr. John David Nicholson Jr., PA is a Physician Assistant in Philadelphia, Pennsylvania. Practices as a sole proprietor. Licensed in Pennsylvania.

Licensed in
PA
In the registry since
2010
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

111 N 49th St
Philadelphia, PA 19139-2718
Phone: (215) 471-2488
Fax: (215) 471-2897
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence MA001440L (PA)

Record details

NPI number1790095933
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorYes
NPI enumeratedOctober 20, 2010
Last updated in NPPESOctober 20, 2010

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