Provider Demographics
NPI:1215376801
Name:NATRAJAN, NITHYA MALTI (MD)
Entity Type:Individual
Prefix:
First Name:NITHYA
Middle Name:MALTI
Last Name:NATRAJAN
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 1:1535 PLATT SPRINGS RD UNIT 3915
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-1078
Mailing Address - Country:US
Mailing Address - Phone:803-470-3774
Mailing Address - Fax:
Practice Address - Street 1:903 15TH ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2607
Practice Address - Country:US
Practice Address - Phone:706-724-8878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL35793207Q00000X
GA78184207Q00000X
SCMD35793207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine