Provider Demographics
NPI:1437179751
Name:NAIR, RAMACHANDRAN V (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMACHANDRAN
Middle Name:V
Last Name:NAIR
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 1:1955 US HIGHWAY 1 S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-3708
Mailing Address - Country:US
Mailing Address - Phone:904-494-2841
Mailing Address - Fax:904-829-6174
Practice Address - Street 1:1955 US HIGHWAY 1 S
Practice Address - Street 2:SUITE 200
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3708
Practice Address - Country:US
Practice Address - Phone:904-494-2841
Practice Address - Fax:904-829-6174
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301040633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110Q26260OtherBCBSM GR#
MI4867128Medicaid
MIRN040633OtherLICENSE
MI0Q26260027OtherGROUP - INTERNIST
MI1508883299OtherWRPH
P00011001OtherRAILROAD
MI110Q26260OtherBCBSM GR#
P00011001OtherRAILROAD