Provider Demographics
NPI:1407167083
Name:ADVANCED HAIR RESTORATION OF OHIO LLC
Entity Type:Organization
Organization Name:ADVANCED HAIR RESTORATION OF OHIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:AGNESI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-533-1570
Mailing Address - Street 1:3869 STARRS CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-8003
Mailing Address - Country:US
Mailing Address - Phone:330-533-1570
Mailing Address - Fax:330-702-9934
Practice Address - Street 1:3869 STARRS CENTRE DR
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-8003
Practice Address - Country:US
Practice Address - Phone:330-533-1570
Practice Address - Fax:330-702-9934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055333208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty