Provider Demographics
NPI:1548242647
Name:NAHM, FREDERICK K (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:K
Last Name:NAHM
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 1:24 HOME PL
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-7106
Mailing Address - Country:US
Mailing Address - Phone:203-661-9383
Mailing Address - Fax:203-661-6724
Practice Address - Street 1:24 HOME PL
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-7106
Practice Address - Country:US
Practice Address - Phone:203-661-9383
Practice Address - Fax:203-661-6724
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040098246ZE0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001400986Medicaid
CT001400986Medicaid
CT130000624Medicare ID - Type Unspecified