Dr. Nicholas Walter Detore, M.D.
Internal Medicine in Mentor, OH. Individual provider (NPI-1).
NPI number1942438197
StatusActive
Last updated in NPPESMar 2, 2021
Details
- NPI
- 1942438197
- Entity type
- Individual (NPI-1)
- Name
- Dr. Nicholas Walter Detore
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 26, 2009
- Certification date
- Mar 2, 2021
- Last updated
- Mar 2, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | 35.098967 | OH | Yes |
Practice location
9485 Mentor AveSuite 210
Mentor, OH 44060-4597
Phone 440-205-5892 · Fax 440-205-5744
Mailing address
9485 Mentor AveSuite 210
Mentor, OH 44060-4597
Phone 440-205-5892 · Fax 440-205-5744
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