1487219127 NPI number — NINO NOZADZE MD

Table of content: NINO NOZADZE MD (NPI 1487219127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487219127 NPI number — NINO NOZADZE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOZADZE
Provider First Name:
NINO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487219127
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UCONN GRADUATE MEDICAL EDUCATION
Provider Second Line Business Mailing Address:
263 FARMINGTON AVENUE LM068
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06030-1921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-679-4763
Provider Business Mailing Address Fax Number:
860-679-4624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SAINT FRANCIS HOSPITAL CLINIC
Provider Second Line Business Practice Location Address:
1000 ASYLUM AVENUE, SUITE 1004
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-714-4532
Provider Business Practice Location Address Fax Number:
860-714-8275
Provider Enumeration Date:
05/08/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)