Healthcare Provider Details

I. General information

NPI: 1508610148
Provider Name (Legal Business Name): NICKOLAS CHARLES TROGDON FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 CENTRAL AVE
DUNKIRK NY
14048-2538
US

IV. Provider business mailing address

609 CENTRAL AVE
DUNKIRK NY
14048-2538
US

V. Phone/Fax

Practice location:
  • Phone: 716-650-5720
  • Fax: 716-650-4618
Mailing address:
  • Phone: 716-650-5720
  • Fax: 716-650-4618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number358345
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number108418
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: