Provider Demographics
NPI:1063458107
Name:JOHNSON, ALEDA NASH (MD)
Entity Type:Individual
Prefix:
First Name:ALEDA
Middle Name:NASH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALEDA
Other - Middle Name:CHARRISE
Other - Last Name:NASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7136 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2261
Mailing Address - Country:US
Mailing Address - Phone:513-377-5191
Mailing Address - Fax:
Practice Address - Street 1:7136 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2261
Practice Address - Country:US
Practice Address - Phone:513-377-5191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082882J207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2444975Medicaid
OHH223810Medicare PIN
OH2444975Medicaid