Provider Demographics
NPI:1548208903
Name:NADZAM, GEOFFREY SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:SCOTT
Last Name:NADZAM
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 1:23 COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-1750
Mailing Address - Country:US
Mailing Address - Phone:203-287-1717
Mailing Address - Fax:
Practice Address - Street 1:330 ORCHARD ST
Practice Address - Street 2:SUITE 309
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4417
Practice Address - Country:US
Practice Address - Phone:203-776-4677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042451208600000X
CAA74061208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTI09314Medicare UPIN