Provider Demographics
NPI:1942438197
Name:DETORE, NICHOLAS WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:WALTER
Last Name:DETORE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:9485 MENTOR AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4597
Mailing Address - Country:US
Mailing Address - Phone:440-205-5892
Mailing Address - Fax:440-205-5744
Practice Address - Street 1:9485 MENTOR AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4597
Practice Address - Country:US
Practice Address - Phone:440-205-5892
Practice Address - Fax:440-205-5744
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2021-03-02
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Provider Licenses
StateLicense IDTaxonomies
OH35.098967207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine