Provider Demographics
NPI:1437384161
Name:NASH, JORDAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:A
Last Name:NASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1680
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25717
Mailing Address - Country:US
Mailing Address - Phone:304-697-1396
Mailing Address - Fax:304-297-2086
Practice Address - Street 1:111 GREAT TEAYS BLVD
Practice Address - Street 2:
Practice Address - City:SCOTT DEPOT
Practice Address - State:WV
Practice Address - Zip Code:25560-9548
Practice Address - Country:US
Practice Address - Phone:304-757-8459
Practice Address - Fax:304-757-6904
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24824208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0075746Medicaid
WV3810023601Medicaid
WV7100239930Medicaid
WVWV3589C729Medicare PIN
WVWV1937C604Medicare PIN
WV3810023601Medicaid
WV7100239930Medicaid