Provider Demographics
NPI:1003959974
Name:NAINI, PRANITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:PRANITHA
Middle Name:
Last Name:NAINI
Suffix:
Gender:F
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 749495
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9495
Mailing Address - Country:US
Mailing Address - Phone:239-432-8331
Mailing Address - Fax:813-321-1296
Practice Address - Street 1:44055 RIVERSIDE PKWY STE 224
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-5177
Practice Address - Country:US
Practice Address - Phone:703-858-3110
Practice Address - Fax:703-858-3111
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0010465207RH0000X, 207RX0202X
VA0101273576207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD412367100Medicaid
MDS589R018Medicare PIN