Provider Demographics
NPI:1003093972
Name:NAINA, MUTHUVAPPA AHAMED
Entity Type:Individual
Prefix:
First Name:MUTHUVAPPA
Middle Name:AHAMED
Last Name:NAINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:AHAMED
Other - Middle Name:M
Other - Last Name:NAINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:26 JOANNE CT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12209-1514
Mailing Address - Country:US
Mailing Address - Phone:518-449-8571
Mailing Address - Fax:
Practice Address - Street 1:493 DELAWARE AVENUE
Practice Address - Street 2:RITE-AID #10694
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12209
Practice Address - Country:US
Practice Address - Phone:518-472-1206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00985837Medicaid