Provider Demographics
NPI:1215229612
Name:JASANI, NIRAV MANUBHAI (MD)
Entity Type:Individual
Prefix:
First Name:NIRAV
Middle Name:MANUBHAI
Last Name:JASANI
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 1:2402 CAMDEN ST SW
Mailing Address - Street 2:SUITE 700
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-8608
Mailing Address - Country:US
Mailing Address - Phone:252-293-9898
Mailing Address - Fax:252-293-9915
Practice Address - Street 1:2402 CAMDEN ST SW
Practice Address - Street 2:SUITE 700
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-8608
Practice Address - Country:US
Practice Address - Phone:252-293-9898
Practice Address - Fax:252-293-9915
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2011-01392207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program