Healthcare Provider Details

I. General information

NPI: 1952311805
Provider Name (Legal Business Name): JOHN A. NAZARIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 01/07/2024
Certification Date: 01/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2446 ALBANY AVE
WEST HARTFORD CT
06117-2598
US

IV. Provider business mailing address

795 PROSPECT AVE APT A5
WEST HARTFORD CT
06105-4225
US

V. Phone/Fax

Practice location:
  • Phone: 609-935-5248
  • Fax: 860-413-0988
Mailing address:
  • Phone: 860-993-5524
  • Fax: 860-413-0988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number034554
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number034554
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: