Healthcare Provider Details

I. General information

NPI: 1750350559
Provider Name (Legal Business Name): MARCUS NICHOLS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 WAYNE ST STE 206
MARIETTA OH
45750-3300
US

IV. Provider business mailing address

416 COLEGATE DR BLDG 3
MARIETTA OH
45750-9549
US

V. Phone/Fax

Practice location:
  • Phone: 740-373-7999
  • Fax: 740-373-3151
Mailing address:
  • Phone: 740-374-3526
  • Fax: 740-374-3165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34-00-8658
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34-00-8658
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: