Organization
NICHOLAS LANDRY D.O. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICHOLAS V LANDRY D.O. (CEO)
(740) 441-9800
Entity
Organization
Contact information
Practice address
1354 JACKSON PIKE, GALLIPOLIS, OH 45631-2601
(740) 441-9800
(740) 441-9400
Mailing address
1325 NORTHUP RD, GALLIPOLIS, OH 45631-8830
(740) 441-9800
(740) 441-9400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
$$$$$$$$$
SOCIAL SECURITY NUMBER
WV
01
—
000000303053
ANTHEM
OH
05
—
2144067
—
OH
05
—
5630097000
—
WV
Enumeration date
09/26/2006
Last updated
05/21/2020
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