Individual
DR. JEFFREY SCOTT NICKLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1044 BELMONT AVE, YOUNGSTOWN, OH 44504-1006
(330) 480-3658
(330) 286-5396
Mailing address
4135 BOARDMAN CANFIELD RD STE 101, CANFIELD, OH 44406-9803
(330) 286-5330
(330) 286-5396
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
35.066875
OH
207L00000X
Anesthesiology Physician
MD443825
PA
207L00000X
Anesthesiology Physician
MT190045
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0056821
—
OH
01
—
11176372
CAQH
—
01
—
227307
MEDICARE PTAN
PA
01
—
4119641
MEDICARE PTAN
OH
Enumeration date
08/01/2007
Last updated
11/11/2020
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