Provider Demographics
NPI:1245412949
Name:KANAL, NIRMAL (MD)
Entity Type:Individual
Prefix:
First Name:NIRMAL
Middle Name:
Last Name:KANAL
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 1:1096 N SHENANDOAH AVE
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-3547
Mailing Address - Country:US
Mailing Address - Phone:540-636-1819
Mailing Address - Fax:540-622-2658
Practice Address - Street 1:1096 N SHENANDOAH AVE
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-3547
Practice Address - Country:US
Practice Address - Phone:540-636-1819
Practice Address - Fax:540-622-2658
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031760207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006164OtherANTHEM BLUE SHIELD
VAVA006392032Medicaid
VAVA006392032Medicaid
VA006164OtherANTHEM BLUE SHIELD