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General NPI Number Information
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NPI Number | 1992233761
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Entity Type | Individual
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Provider Name | NICHOLAS CHAPMAN BONIFACE MD, MPH
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Gender | Male
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Dates
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Enumeration Date | 05/24/2017
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 7600 SOUTHERN BLVD STE 2
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-6085
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Country | US
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Telephone | 234-367-8181
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Fax | 614-591-3981
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Provider Business Mailing Address
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Address Line | 7600 SOUTHERN BLVD STE 2
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-6085
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Country | US
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Telephone | 330-758-8183
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | MD482959
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 35.136025
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License Number State | OH
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