Healthcare Provider Details

I. General information

NPI: 1578922902
Provider Name (Legal Business Name): BRIAN MCNICHOLAS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 EASTLAND AVE SE ST. JOSEPH WARREN HOSPITAL EMERGENCY DEPT
WARREN OH
44484-4503
US

IV. Provider business mailing address

493 AURORA DR
YOUNGSTOWN OH
44505-1105
US

V. Phone/Fax

Practice location:
  • Phone: 330-841-4029
  • Fax:
Mailing address:
  • Phone: 708-674-4238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02005946A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.013992
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: