Healthcare Provider Details

I. General information

NPI: 1679918676
Provider Name (Legal Business Name): NICHOLAS ONYEADOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2013
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST
CINCINNATI OH
45219-2364
US

IV. Provider business mailing address

14 HAWSER WAY
RANDOLPH NJ
07869-1263
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-7355
  • Fax: 513-584-0431
Mailing address:
  • Phone: 973-906-6867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35139271
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: