Provider Demographics
NPI:1831121193
Name:NICOLAS, VICTOR T (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:T
Last Name:NICOLAS
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:PO BOX 640929
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-0929
Mailing Address - Country:US
Mailing Address - Phone:513-727-0748
Mailing Address - Fax:937-293-0960
Practice Address - Street 1:105 MCKNIGHT DRIVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-4898
Practice Address - Country:US
Practice Address - Phone:513-424-2111
Practice Address - Fax:513-420-5662
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053137N207L00000X
OH35053137207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0628182Medicaid
OH000000015848OtherANTHEM
OH2020092OtherUNITED HEALTHCARE
E72196Medicare UPIN
OH0646963Medicare ID - Type Unspecified
OH000000015848OtherANTHEM