Provider Demographics
NPI:1477539674
Name:NICHOLSON, OSCAR JR (MD)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:
Last Name:NICHOLSON
Suffix:JR
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:OSCAR
Other - Middle Name:
Other - Last Name:NICHOLSON
Other - Suffix:VII
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1163 BERWICK LANE
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121
Mailing Address - Country:US
Mailing Address - Phone:216-407-2234
Mailing Address - Fax:216-691-0030
Practice Address - Street 1:1163 BERWICK LANE
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121
Practice Address - Country:US
Practice Address - Phone:216-691-0028
Practice Address - Fax:216-691-0030
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35056957208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0881498Medicaid
OH0881498Medicaid
F46929Medicare UPIN