Healthcare Provider Details

I. General information

NPI: 1861070815
Provider Name (Legal Business Name): NICHOLAS COCOROS YEATTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 05/22/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN STREET
CINCINNATI OH
45219-0796
US

IV. Provider business mailing address

UNIV CINCINNATI DEPT ANESTHESIOLOGY 3188 BELLEVUE AVE
CINCINNATI OH
45219
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-6356
  • Fax: 513-558-3474
Mailing address:
  • Phone: 513-558-4206
  • Fax: 513-558-3474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number57.251015
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: