Basic Information
| Provider Information | |||||||||
| NPI: | 1376540906 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NASH | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | DALE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIVERSITY OF CONNECTICUT HEALTH CTR | ||||||||
| Address2: | 263 FARMINGTON AVENUE - MC1614 | ||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060300001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606796052 | ||||||||
| FaxNumber: | 8606794973 | ||||||||
| Practice Location | |||||||||
| Address1: | UNIVERSITY OF CONNECTICUT HEALTH CTR | ||||||||
| Address2: | 263 FARMINGTON AVENUE - MC1614 | ||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060300001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606796052 | ||||||||
| FaxNumber: | 8606794973 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2005 | ||||||||
| LastUpdateDate: | 05/07/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0201X | 0101239254 | VA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
ID Information
| ID | Type | State | Issuer | Description | 10239079 | 05 | VA | MEDICAID |