Provider Demographics
NPI:1962435404
Name:NABHA, ANANTH P (MD)
Entity type:Individual
Prefix:
First Name:ANANTH
Middle Name:P
Last Name:NABHA
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 1:2006 LIMESTONE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5553
Mailing Address - Country:US
Mailing Address - Phone:302-999-0105
Mailing Address - Fax:302-998-1905
Practice Address - Street 1:2006 LIMESTONE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5553
Practice Address - Country:US
Practice Address - Phone:302-999-0105
Practice Address - Fax:302-998-1905
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10001599208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000029701Medicaid
DE0000029701Medicaid
DE143023Medicare ID - Type UnspecifiedMEDICARE