Provider Demographics
NPI:1669003281
Name:NICHOLAS, JAMES ROGER (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ROGER
Last Name:NICHOLAS
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 1:11170 MAPLE KNOLL TER UNIT L215
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-4154
Mailing Address - Country:US
Mailing Address - Phone:218-235-1466
Mailing Address - Fax:
Practice Address - Street 1:11170 MAPLE KNOLL TER UNIT L215
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-4154
Practice Address - Country:US
Practice Address - Phone:218-235-1466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-02
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0217582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry