Healthcare Provider Details

I. General information

NPI: 1033841051
Provider Name (Legal Business Name): NICHOLAS WOODARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SIXTH ST SW
CANTON OH
44710-1702
US

IV. Provider business mailing address

2600 SIXTH ST SW
CANTON OH
44710-1702
US

V. Phone/Fax

Practice location:
  • Phone: 330-363-6211
  • Fax: 330-453-4263
Mailing address:
  • Phone: 330-363-6211
  • Fax: 330-453-4263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.153626
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: