Provider Demographics
NPI:1750350559
Name:NICHOLS, MARCUS (DO)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:DO
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 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:802 WAYNE ST
Practice Address - Street 2:SUITE 206
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-3300
Practice Address - Country:US
Practice Address - Phone:740-373-7999
Practice Address - Fax:740-373-3151
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-8658208000000X, 207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2612579Medicaid
WV3810005284Medicaid
OH000000540905OtherANTHEM
WV3810005284Medicaid
OHP01430943OtherRAILROAD MEDICARE - MHCPI
OHP01430943OtherRAILROAD MEDICARE - MHCPI
OH000000699809OtherANTHEM
OH000000540905OtherANTHEM