Provider Demographics
NPI:1134100761
Name:DONINGER, NICHOLAS A (PHD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:A
Last Name:DONINGER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30E APPLE ST 6254
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2939
Mailing Address - Country:US
Mailing Address - Phone:937-208-2554
Mailing Address - Fax:937-208-3893
Practice Address - Street 1:3533 SOUTHERN BLVD
Practice Address - Street 2:SUITE 5200
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1264
Practice Address - Country:US
Practice Address - Phone:937-395-8043
Practice Address - Fax:937-395-8139
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6061103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00299273OtherMEDICARE RR
OH2523782Medicaid
OHDOCP30381Medicare PIN
OHP00299273OtherMEDICARE RR