Provider Demographics
NPI:1285123372
Name:NINAN, SIDDHARTH PHILIP (MD)
Entity type:Individual
Prefix:DR
First Name:SIDDHARTH
Middle Name:PHILIP
Last Name:NINAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3020 HAMAKER CT STE 400
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2231
Mailing Address - Country:US
Mailing Address - Phone:703-876-0800
Mailing Address - Fax:703-564-0057
Practice Address - Street 1:3020 HAMAKER CT STE 400
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2231
Practice Address - Country:US
Practice Address - Phone:703-876-0800
Practice Address - Fax:703-876-0866
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101-2749772084N0400X
VA01012749772084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology