Provider Demographics
NPI:1548224934
Name:NATH, SANIL RAVINDRA (MD)
Entity Type:Individual
Prefix:
First Name:SANIL
Middle Name:RAVINDRA
Last Name:NATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7331 HANOVER PKWY
Mailing Address - Street 2:STE B
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3621
Mailing Address - Country:US
Mailing Address - Phone:301-345-0605
Mailing Address - Fax:301-345-0606
Practice Address - Street 1:7331 HANOVER PKWY
Practice Address - Street 2:STE B
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3621
Practice Address - Country:US
Practice Address - Phone:301-345-0605
Practice Address - Fax:301-345-0606
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053107207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
61141202OtherBSMD
LX76CEOtherBSMD
MD774002600Medicaid
F4550003OtherBSDC
MD774002600Medicaid
61141202OtherBSMD
DC014643C73Medicare ID - Type Unspecified