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Individual

DR. NICHOLAS VITO LANDRY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.O.

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
34006760
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000303053
ANTHEM
OH
05
2144067
OH
01
300147896027
CORESOURCE
OH
01
340066272001
MEDICAL MUTUAL OF OHIO
OH
01
340066272007
MEDICAL MUTUAL OF OMAHA
OH
05
5630097000
WV
01
7108004
AETNA
OH
Enumeration date
12/15/2005
Last updated
06/07/2019
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