Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 0101230472 | VA |
NPI | 1013937564 |
---|---|
Provider Name | Dr. Rajiv B Nanavaty |
First Address | Suffolk, VA 23434-8168 |
Second Address | Suffolk, VA 23434-8168 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 15/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007102925 | (05) | VA |
130025269 | MEDICARE RR (01) | VA |
H58376 | (02) | VA |