Provider Demographics
NPI:1063694669
Name:UDAY B NANAVATY, MD LLC
Entity type:Organization
Organization Name:UDAY B NANAVATY, MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSCIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:UDAY
Authorized Official - Middle Name:B
Authorized Official - Last Name:NANAVATY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-747-8880
Mailing Address - Street 1:700 GEIPE RD
Mailing Address - Street 2:SUITE 267-C
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5281
Mailing Address - Country:US
Mailing Address - Phone:410-747-8880
Mailing Address - Fax:410-747-8882
Practice Address - Street 1:700 GEIPE RD
Practice Address - Street 2:SUITE 267-C
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4147
Practice Address - Country:US
Practice Address - Phone:410-747-8880
Practice Address - Fax:410-747-8882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051119207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD702000700Medicaid
MD056NMedicare PIN