Provider Demographics
NPI:1952311805
Name:NAZARIAN, JOHN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:NAZARIAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:795 PROSPECT AVE APT A5
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-4225
Mailing Address - Country:US
Mailing Address - Phone:860-993-5524
Mailing Address - Fax:860-413-0988
Practice Address - Street 1:2446 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2598
Practice Address - Country:US
Practice Address - Phone:609-935-5248
Practice Address - Fax:860-413-0988
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2024-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0345542084P0802X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1952311805Medicaid
CT1952311805Medicaid
CTG31625Medicare UPIN
CT260004753Medicare PIN