Provider Demographics
NPI:1942203922
Name:PASTIS, NICHOLAS J JR (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:J
Last Name:PASTIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-6939
Mailing Address - Fax:614-293-3919
Practice Address - Street 1:300 W 10TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1280
Practice Address - Country:US
Practice Address - Phone:614-293-6939
Practice Address - Fax:614-293-3919
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2022-05-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC23682207RC0200X, 207RP1001X, 207RS0012X
OH35.142334207RP1001X, 207RS0012X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC236827Medicaid
SC236827Medicaid