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NPI Code Detail

MEDICARE: DR. NICKLAS B OLDENBURG M.D.

MEDICARE: DR. NICKLAS B OLDENBURG M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0001XRadiation Oncology Physician205005MA
22085R0001XRadiation Oncology PhysicianMD10931RI

General Provider Information

NPI Number : 1801899760
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NICKLAS B OLDENBURG M.D.
Provider Business Mailing Address
First Line : 825 N MAIN ST
Second Line :
City : PROVIDENCE
State : RI
Zip : 02904-5767
Country : US
Telephone Number : 401-521-9700
Fax Number : 401-751-1686
Provider Business Practice Location Address
First Line : 825 N MAIN ST
Second Line :
City : PROVIDENCE
State : RI
Zip : 02904-5707
Country : US
Telephone Number : 401-521-9700
Fax Number : 401-751-1686
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 03/10/2026

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