Healthcare Provider Details

I. General information

NPI: 1992233761
Provider Name (Legal Business Name): NICHOLAS CHAPMAN BONIFACE MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 SOUTHERN BLVD STE 2
YOUNGSTOWN OH
44512-6085
US

IV. Provider business mailing address

7600 SOUTHERN BLVD STE 2
YOUNGSTOWN OH
44512-6085
US

V. Phone/Fax

Practice location:
  • Phone: 234-367-8181
  • Fax: 614-591-3981
Mailing address:
  • Phone: 330-758-8183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD482959
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.136025
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: