MEDICARE: DR. NICHOLAS ALEXANDER GASTALDO DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	34.017511	OH

General Provider Information

NPI Number	:	1235626821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS ALEXANDER GASTALDO DO

Provider Business Mailing Address
First Line	:	627 EASTLAND AVE SE STE 201
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44484-4501
Country	:	US
Telephone Number	:	330-841-4477
Fax Number	:

Provider Business Practice Location Address
First Line	:	627 EASTLAND AVE SE STE 201
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44484-4501
Country	:	US
Telephone Number	:	330-841-4477
Fax Number	:	330-841-4505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2018
Last Update Date	:	02/10/2026

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