Provider Demographics
NPI:1538115639
Name:TROY, NICOLE CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:CHRISTINE
Last Name:TROY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8055 MAYFIELD RD
Mailing Address - Street 2:STE 105
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-2447
Mailing Address - Country:US
Mailing Address - Phone:440-214-8027
Mailing Address - Fax:216-201-8173
Practice Address - Street 1:563 W BAGLEY RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1328
Practice Address - Country:US
Practice Address - Phone:440-234-0502
Practice Address - Fax:440-234-0590
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2021-01-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35-085106207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1538115639OtherNPI
OH2562810Medicaid
4160201Medicare PIN
I31242Medicare UPIN