Healthcare Provider Details

I. General information

NPI: 1861479883
Provider Name (Legal Business Name): NICHOLAS CARDINAL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1296 TOD PL NW SUITE 200
WARREN OH
44485-2474
US

IV. Provider business mailing address

5700 DARROW RD SUITE 106
HUDSON OH
44236-5021
US

V. Phone/Fax

Practice location:
  • Phone: 330-841-4000
  • Fax: 330-656-5901
Mailing address:
  • Phone: 330-656-5911
  • Fax: 330-656-5901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34008609
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: