Basic Information
| Provider Information | |||||||||
| NPI: | 1639368186 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBERTS | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | BRIAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 TUSCARAWAS ST W | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447084644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304534300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2600 TUSCARAWAS ST W | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447084644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304534300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2007 | ||||||||
| LastUpdateDate: | 11/27/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 57.013793 | OH | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.