Provider Demographics
NPI:1417947011
Name:NAIR, SUDHA R (MD)
Entity Type:Individual
Prefix:DR
First Name:SUDHA
Middle Name:R
Last Name:NAIR
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 1:10810 PARKSIDE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1980
Mailing Address - Country:US
Mailing Address - Phone:865-218-6660
Mailing Address - Fax:865-218-6661
Practice Address - Street 1:10810 PARKSIDE DR STE 100
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1980
Practice Address - Country:US
Practice Address - Phone:865-218-6660
Practice Address - Fax:865-218-6661
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMDMD0000037406207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H88984Medicare UPIN
TN3886355Medicare ID - Type UnspecifiedMEDICARE #