Healthcare Provider Details

I. General information

NPI: 1457383812
Provider Name (Legal Business Name): NICHOLAS JOHN CARLEVATO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 IDAHO ST
ELKO NV
89801
US

IV. Provider business mailing address

2102 IDAHO ST
ELKO NV
89801-2625
US

V. Phone/Fax

Practice location:
  • Phone: 775-315-2902
  • Fax: 775-460-2368
Mailing address:
  • Phone: 775-315-2902
  • Fax: 775-460-2368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number9307
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number9307
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG75259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: