Individual
DR. NICHOLAS MANCUSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 ROSE ST RM M-53, LEXINGTON, KY 40536-0293
(859) 323-5083
(859) 323-5682
Mailing address
800 ROSE ST RM M-53, LEXINGTON, KY 40536-0293
(859) 323-5083
(859) 323-5682
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
R3841
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/25/2015
Last updated
06/27/2016
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