Basic Information
| Provider Information | |||||||||
| NPI: | 1538115639 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TROY | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | CHRISTINE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8055 MAYFIELD RD | ||||||||
| Address2: | STE 105 | ||||||||
| City: | CHESTERLAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440262447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402148027 | ||||||||
| FaxNumber: | 2162018173 | ||||||||
| Practice Location | |||||||||
| Address1: | 563 W BAGLEY RD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | BEREA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440171328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402340502 | ||||||||
| FaxNumber: | 4402340590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 01/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35-085106 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1538115639 | 01 | OH | NPI | OTHER | 2562810 | 05 | OH | MEDICAID |