Healthcare Provider Details

I. General information

NPI: 1033748579
Provider Name (Legal Business Name): NICHOLAS C GEMMA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9371 E MARKET ST STE 2
WARREN OH
44484-5551
US

IV. Provider business mailing address

100 DEBARTOLO PL STE 200
YOUNGSTOWN OH
44512-6095
US

V. Phone/Fax

Practice location:
  • Phone: 234-287-6590
  • Fax: 234-287-6380
Mailing address:
  • Phone: 330-729-8145
  • Fax: 330-965-5229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number34.018016
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: