MEDICARE: KAREN J. NISHIDA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VX0201X	Gynecologic Oncology Physician	052404	CT

General Provider Information

NPI Number	:	1962509653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN J. NISHIDA MD

Provider Business Mailing Address
First Line	:	1290 SUMMER ST STE 5200
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06905-5339
Country	:	US
Telephone Number	:	203-998-0848
Fax Number	:	203-323-0566

Provider Business Practice Location Address
First Line	:	1290 SUMMER ST STE 5200
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06905-5339
Country	:	US
Telephone Number	:	203-998-0848
Fax Number	:	203-323-0566

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	01/15/2015

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