Provider Demographics
NPI:1306089834
Name:AGNESI, NICHOLAS FRANK (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:FRANK
Last Name:AGNESI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:813 KENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5004
Mailing Address - Country:US
Mailing Address - Phone:330-533-1570
Mailing Address - Fax:
Practice Address - Street 1:813 KENTWOOD DR
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5004
Practice Address - Country:US
Practice Address - Phone:330-533-1570
Practice Address - Fax:330-953-2368
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35. 055333208600000X
OH35. 0553332086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery