Healthcare Provider Details

I. General information

NPI: 1023683638
Provider Name (Legal Business Name): NICHOLAS ROSS GOZZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6780 MAYFIELD RD
MAYFIELD HEIGHTS OH
44124-2203
US

IV. Provider business mailing address

6780 MAYFIELD RD
MAYFIELD HEIGHTS OH
44124-2203
US

V. Phone/Fax

Practice location:
  • Phone: 440-312-4500
  • Fax:
Mailing address:
  • Phone: 440-312-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.150395
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: