Provider Demographics
NPI:1699864637
Name:NASH, TAMMON ANTOINETTE (MD)
Entity type:Individual
Prefix:DR
First Name:TAMMON
Middle Name:ANTOINETTE
Last Name:NASH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400- CREDENTIALING DEPARTMENT
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1138
Mailing Address - Country:US
Mailing Address - Phone:313-745-8555
Mailing Address - Fax:313-745-9299
Practice Address - Street 1:3990 JOHN R ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2018
Practice Address - Country:US
Practice Address - Phone:313-745-8555
Practice Address - Fax:313-745-9299
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2015-06-10
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Provider Licenses
StateLicense IDTaxonomies
MI4301080091207ZB0001X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine