Healthcare Provider Details

I. General information

NPI: 1336593276
Provider Name (Legal Business Name): JOSEPH NICOLAZZI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1083 BOILING SPRINGS RD
SPARTANBURG SC
29303-2298
US

IV. Provider business mailing address

1083 BOILING SPRINGS RD
SPARTANBURG SC
29303-2298
US

V. Phone/Fax

Practice location:
  • Phone: 864-583-8647
  • Fax: 864-542-2227
Mailing address:
  • Phone: 864-583-8647
  • Fax: 864-542-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0102205944
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number89685
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: