Provider Demographics
NPI:1932384930
Name:NICHOLS, TANN A (MD)
Entity Type:Individual
Prefix:
First Name:TANN
Middle Name:A
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 643398
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-3398
Mailing Address - Country:US
Mailing Address - Phone:513-221-1100
Mailing Address - Fax:513-569-5297
Practice Address - Street 1:544 CENTRE VIEW BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3400
Practice Address - Country:US
Practice Address - Phone:513-221-1100
Practice Address - Fax:859-341-3913
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.090865207T00000X
KY41374207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35.090865OtherOHIO MEDICAL LICENSE