Healthcare Provider Details

I. General information

NPI: 1548242647
Provider Name (Legal Business Name): FREDERICK K NAHM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HOME PL
GREENWICH CT
06830-7106
US

IV. Provider business mailing address

24 HOME PL
GREENWICH CT
06830-7106
US

V. Phone/Fax

Practice location:
  • Phone: 203-661-9383
  • Fax: 203-661-6724
Mailing address:
  • Phone: 203-661-9383
  • Fax: 203-661-6724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number040098
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number040098
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: