Provider Demographics
NPI:1013016062
Name:NANAGAS, VICTOR N JR (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:N
Last Name:NANAGAS
Suffix:JR
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 1:4718 EAGLES NEST CIRCLE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429
Mailing Address - Country:US
Mailing Address - Phone:937-293-3077
Mailing Address - Fax:
Practice Address - Street 1:ONE CHILDRENS PLAZA
Practice Address - Street 2:STE 2071
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404
Practice Address - Country:US
Practice Address - Phone:937-461-5020
Practice Address - Fax:937-641-3107
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350387542086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0388496Medicaid