Provider Demographics
NPI:1346372828
Name:BISCONTI, NICHOLAS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:BISCONTI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80690
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-0690
Mailing Address - Country:US
Mailing Address - Phone:330-363-7444
Mailing Address - Fax:330-363-7770
Practice Address - Street 1:2600 SEVENTH ST SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1709
Practice Address - Country:US
Practice Address - Phone:330-453-4300
Practice Address - Fax:330-453-3617
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35054433174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0787402Medicaid
OHBI0674431Medicare ID - Type Unspecified
OHE68494Medicare UPIN