Healthcare Provider Details

I. General information

NPI: 1225395361
Provider Name (Legal Business Name): NICHOLAS J PETERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 FRED TAYLOR DR FL 2
COLUMBUS OH
43202-1552
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-3600
  • Fax: 614-293-2910
Mailing address:
  • Phone: 614-293-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35.132291
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number35.132291
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: