Provider Demographics
NPI:1508270323
Name:BRICKNER, NICHOLAS JAMES (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JAMES
Last Name:BRICKNER
Suffix:
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 1:799 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1906
Mailing Address - Country:US
Mailing Address - Phone:419-756-5133
Mailing Address - Fax:419-774-9707
Practice Address - Street 1:799 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1906
Practice Address - Country:US
Practice Address - Phone:419-756-5133
Practice Address - Fax:419-774-9707
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101259757207L00000X
390200000X
OH35.143478207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program