Provider Demographics
NPI:1679100408
Name:ANDERSON, NICHOLAS BEECHER (DO)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:BEECHER
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 AFRICA RD STE 340
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9830
Mailing Address - Country:US
Mailing Address - Phone:614-901-2273
Mailing Address - Fax:614-901-3140
Practice Address - Street 1:625 AFRICA RD STE 340
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-9830
Practice Address - Country:US
Practice Address - Phone:614-901-2273
Practice Address - Fax:614-901-3140
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.016321207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine