Provider Demographics
NPI:1649388604
Name:NASH, ELBERT JOHN (DO)
Entity Type:Individual
Prefix:
First Name:ELBERT
Middle Name:JOHN
Last Name:NASH
Suffix:
Gender:M
Credentials:DO
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 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1106 COLEGATE DR
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1323
Practice Address - Country:US
Practice Address - Phone:740-568-2000
Practice Address - Fax:740-568-2096
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008596207P00000X
WV2136207R00000X
OH34. 008596207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810007915Medicaid
OH2698406Medicaid
OHP01029465OtherRAILROAD MEDICARE
OHH026771Medicare PIN
OHH026772Medicare PIN
OHH026771Medicare PIN
OHH026770Medicare PIN