Provider Demographics
NPI: | 1013090141 |
---|---|
Name: | NAHUM, DANIEL DAVID (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | DANIEL |
Middle Name: | DAVID |
Last Name: | NAHUM |
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: | 2333 ALUMNI PARK PLZ |
Mailing Address - Street 2: | SUITE 200 |
Mailing Address - City: | LEXINGTON |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 40517-4012 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 859-257-7910 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3470 BLAZER PKWY |
Practice Address - Street 2: | |
Practice Address - City: | LEXINGTON |
Practice Address - State: | KY |
Practice Address - Zip Code: | 40509-1200 |
Practice Address - Country: | US |
Practice Address - Phone: | 859-323-6021 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-10-23 |
Last Update Date: | 2008-04-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KY | 17441 | 2084P0800X, 2084P0802X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No | 2084P0802X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KY | 64174410 | Medicaid | |
0647534 | Medicare ID - Type Unspecified | ||
KY | 64174410 | Medicaid |