Healthcare Provider Details

I. General information

NPI: 1356478408
Provider Name (Legal Business Name): DAVID JACOB NOCHIMSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 DONAHUE RD
NORTH GRANBY CT
06060-1404
US

IV. Provider business mailing address

15 DONAHUE RD
NORTH GRANBY CT
06060-1404
US

V. Phone/Fax

Practice location:
  • Phone: 860-653-3466
  • Fax: 860-653-3238
Mailing address:
  • Phone: 860-653-3466
  • Fax: 860-653-3238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number021601
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: