Provider Demographics
NPI:1376540906
Name:NASH, JOHN DALE (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DALE
Last Name:NASH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:UNIVERSITY OF CONNECTICUT HEALTH CTR
Mailing Address - Street 2:263 FARMINGTON AVENUE - MC1614
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-0001
Mailing Address - Country:US
Mailing Address - Phone:860-679-6052
Mailing Address - Fax:860-679-4973
Practice Address - Street 1:UNIVERSITY OF CONNECTICUT HEALTH CTR
Practice Address - Street 2:263 FARMINGTON AVENUE - MC1614
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-0001
Practice Address - Country:US
Practice Address - Phone:860-679-6052
Practice Address - Fax:860-679-4973
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2009-05-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101239254207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10239079Medicaid
VA009605B62Medicare ID - Type Unspecified
VAG41862Medicare UPIN