Provider Demographics
NPI:1942315643
Name:PAPPAS, NICHOLAS ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ANTHONY
Last Name:PAPPAS
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 1:2180 ARMS DR
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-1604
Mailing Address - Country:US
Mailing Address - Phone:330-759-6979
Mailing Address - Fax:330-759-6979
Practice Address - Street 1:2180 ARMS DR
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-1604
Practice Address - Country:US
Practice Address - Phone:330-759-6979
Practice Address - Fax:330-759-6979
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35029380207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAFA0195873Medicaid
OHAFA0195873Medicaid
OHPA0372673Medicare ID - Type Unspecified