Healthcare Provider Details

I. General information

NPI: 1619402617
Provider Name (Legal Business Name): NICHOLAS WADE SALUPO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 WASHINGTON VILLAGE DR STE 230
CENTERVILLE OH
45459-4094
US

IV. Provider business mailing address

1280 WELSFORD CT
CENTERVILLE OH
45459-8702
US

V. Phone/Fax

Practice location:
  • Phone: 937-438-3132
  • Fax:
Mailing address:
  • Phone: 317-748-0773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number34.016052
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: