Healthcare Provider Details

I. General information

NPI: 1477539674
Provider Name (Legal Business Name): OSCAR NICHOLSON JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: OSCAR NICHOLSON VII MD

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 03/12/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1163 BERWICK LANE
SOUTH EUCLID OH
44121
US

IV. Provider business mailing address

1163 BERWICK LANE
SOUTH EUCLID OH
44121
US

V. Phone/Fax

Practice location:
  • Phone: 216-691-0028
  • Fax: 216-691-0030
Mailing address:
  • Phone: 216-407-2234
  • Fax: 216-691-0030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35056957
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: