Provider Demographics
NPI:1992233761
Name:BONIFACE, NICHOLAS CHAPMAN (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:CHAPMAN
Last Name:BONIFACE
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 SOUTHERN BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6085
Mailing Address - Country:US
Mailing Address - Phone:330-758-8183
Mailing Address - Fax:
Practice Address - Street 1:7600 SOUTHERN BLVD STE 2
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-6085
Practice Address - Country:US
Practice Address - Phone:234-367-8181
Practice Address - Fax:614-591-3981
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-24
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4829592086S0127X
OH35.136025208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery