Provider Demographics
NPI:1992762264
Name:ATANASOFF, NICHOLAS A (DO)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:A
Last Name:ATANASOFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8090 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6216
Mailing Address - Country:US
Mailing Address - Phone:330-629-2596
Mailing Address - Fax:330-629-2847
Practice Address - Street 1:819 MCKAY CT STE 102
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5771
Practice Address - Country:US
Practice Address - Phone:330-259-4849
Practice Address - Fax:330-629-2847
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340078372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2509888Medicaid
OHAT4129092Medicare ID - Type Unspecified
OH2509888Medicaid