MEDICARE: JAMES ROGER NICHOLAS MD

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	2084P0800X	Psychiatry Physician	35.021758	OH

General Provider Information

NPI Number	:	1669003281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES ROGER NICHOLAS MD

Provider Business Mailing Address
First Line	:	11170 MAPLE KNOLL TER UNIT L215
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45246-4154
Country	:	US
Telephone Number	:	218-235-1466
Fax Number	:

Provider Business Practice Location Address
First Line	:	11170 MAPLE KNOLL TER UNIT L215
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45246-4154
Country	:	US
Telephone Number	:	218-235-1466
Fax Number	:

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

Provider Enumeration Date	:	02/02/2020
Last Update Date	:	02/02/2020

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