Provider Demographics
NPI:1386736585
Name:NAGAIAH, GOVARDHANAN (MD)
Entity type:Individual
Prefix:
First Name:GOVARDHANAN
Middle Name:
Last Name:NAGAIAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 910221
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-0221
Mailing Address - Country:US
Mailing Address - Phone:520-519-7700
Mailing Address - Fax:
Practice Address - Street 1:13555 W MCDOWELL RD STE 105
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2625
Practice Address - Country:US
Practice Address - Phone:623-487-4822
Practice Address - Fax:623-334-9881
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2013-0149207RH0003X
AZ31774207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ930893Medicaid
AZ31774OtherSTATE LICENSE
OHP00372963OtherRAILROAD MEDICARE
AZ31774OtherSTATE LICENSE
AZ930893Medicaid
AZ31774OtherSTATE LICENSE