Healthcare Provider Details

I. General information

NPI: 1639250145
Provider Name (Legal Business Name): DAVID SCOTT NICHOLSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 STATE ROUTE 725 STE A1
BELLBROOK OH
45305
US

IV. Provider business mailing address

4403 STATE ROUTE 725 STE A1
BELLBROOK OH
45305-2700
US

V. Phone/Fax

Practice location:
  • Phone: 937-310-1218
  • Fax: 937-310-1378
Mailing address:
  • Phone: 937-310-1218
  • Fax: 937-310-1378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number34008874
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: