Healthcare Provider Details

I. General information

NPI: 1255304374
Provider Name (Legal Business Name): NICHOLAS JARMOSZUK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 KOLBE RD SUITE 206
LORAIN OH
44053-1654
US

IV. Provider business mailing address

PO BOX 636643
CINCINNATI OH
45263-6643
US

V. Phone/Fax

Practice location:
  • Phone: 440-282-1360
  • Fax: 440-282-3562
Mailing address:
  • Phone: 440-989-3801
  • Fax: 440-960-0264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number043326
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: