Provider Demographics
NPI:1568044428
Name:NAIR, NIVEDITA (MD)
Entity Type:Individual
Prefix:
First Name:NIVEDITA
Middle Name:
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 1:1102 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1708
Mailing Address - Country:US
Mailing Address - Phone:608-263-3111
Mailing Address - Fax:608-263-6663
Practice Address - Street 1:1102 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1708
Practice Address - Country:US
Practice Address - Phone:608-263-3111
Practice Address - Fax:608-263-6663
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI77832-20207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program