Provider Demographics
NPI:1992716146
Name:PEPONIS, NICHOLAS T (DO)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:T
Last Name:PEPONIS
Suffix:
Gender:M
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:100 E CAMPUS VIEW BLVD
Mailing Address - Street 2:STE 160
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4647
Mailing Address - Country:US
Mailing Address - Phone:614-396-4750
Mailing Address - Fax:614-396-4742
Practice Address - Street 1:3525 OLENTANGY RIVER RD
Practice Address - Street 2:STE 5360
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3937
Practice Address - Country:US
Practice Address - Phone:614-340-7747
Practice Address - Fax:614-340-7742
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34-0035362085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0538878Medicaid
OHE00778Medicare UPIN