Healthcare Provider Details

I. General information

NPI: 1992716146
Provider Name (Legal Business Name): NICHOLAS T PEPONIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 OLENTANGY RIVER RD STE 5360
COLUMBUS OH
43214-3937
US

IV. Provider business mailing address

100 E CAMPUS VIEW BLVD STE 160
COLUMBUS OH
43235-4647
US

V. Phone/Fax

Practice location:
  • Phone: 614-340-7747
  • Fax: 614-340-7742
Mailing address:
  • Phone: 614-396-4750
  • Fax: 614-396-4742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number34-003536
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: