Healthcare Provider Details

I. General information

NPI: 1245228717
Provider Name (Legal Business Name): RICHARD A NOCKOWITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 11/27/2023
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ALLENTOWN RD
LIMA OH
45805-1873
US

IV. Provider business mailing address

1800 ALLENTOWN RD
LIMA OH
45805-1873
US

V. Phone/Fax

Practice location:
  • Phone: 419-229-0415
  • Fax: 419-229-0419
Mailing address:
  • Phone: 419-229-0415
  • Fax: 419-229-0419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number35.072394
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOH72394
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: