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NPI Code Detail

MEDICARE: DR. NICHOLAS VITO LANDRY D.O.

MEDICARE: DR. NICHOLAS VITO LANDRY D.O.
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
1207Q00000XFamily Medicine Physician34006760OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000303053OTHEROHANTHEM
2300147896027OTHEROHCORESOURCE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
57108004OTHEROHAETNA
6340066272001OTHEROHMEDICAL MUTUAL OF OHIO
7340066272007OTHEROHMEDICAL MUTUAL OF OMAHA

General Provider Information

NPI Number : 1992781538
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NICHOLAS VITO LANDRY D.O.
Provider Business Mailing Address
First Line : 1325 NORTHUP RD
Second Line :
City : GALLIPOLIS
State : OH
Zip : 45631-8830
Country : US
Telephone Number : 740-441-9800
Fax Number : 740-441-9400
Provider Business Practice Location Address
First Line : 1354 JACKSON PIKE
Second Line :
City : GALLIPOLIS
State : OH
Zip : 45631-2601
Country : US
Telephone Number : 740-441-9800
Fax Number : 740-441-9400
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2005
Last Update Date : 06/07/2019

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