Provider Demographics
NPI:1588630859
Name:NASON, FAE G (MD)
Entity Type:Individual
Prefix:
First Name:FAE
Middle Name:G
Last Name:NASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5 NEPONSET ST
Mailing Address - Street 2:WOT 2ND FL, STE C203
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-368-3110
Mailing Address - Fax:508-368-3113
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1216
Practice Address - Country:US
Practice Address - Phone:508-368-3110
Practice Address - Fax:508-968-3113
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA76444207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
7400028OtherEVERCARE
26859OtherHEALTHY START
3118274OtherWELFARE
3615046OtherAETNA
7668718OtherCIGNA HEALTH PLAN
AA6087OtherHARVARD PILGRIM HLTHCARE
J30255OtherBLUE SHIELD HMO BLUE
042472266OtherONE HEALTH PLAN
26859OtherCHILDRENS MED SEC PLAN
MA3118274Medicaid
3615046OtherUS HEALTHCARE
042472266OtherHEALTHCARE VALUE MGMT
784224OtherMVP HEALTH CARE
918079OtherFIRST HEALTH
9901091OtherFALLON COMM HEALTH PLAN
J30255OtherBLUE SHIELD INDEMNITY
J30255OtherBLUE CARE ELECT
J30255OtherMEDICARE B
F72098Medicare UPIN
MAJ30255Medicare ID - Type Unspecified