Provider Demographics
NPI:1760416200
Name:NICHOLS, JAMES ANDREW (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ANDREW
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1932 NILES CORTLAND RD NE STE P
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-1055
Mailing Address - Country:US
Mailing Address - Phone:330-856-7702
Mailing Address - Fax:330-856-1096
Practice Address - Street 1:1932 NILES CORTLAND RD NE STE P
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1055
Practice Address - Country:US
Practice Address - Phone:330-856-7702
Practice Address - Fax:330-856-1096
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.007740207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2350174Medicaid
OHH167560Medicare PIN