Provider Demographics
NPI:1588002059
Name:NATHOO, RAJIV KIRAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJIV
Middle Name:KIRAN
Last Name:NATHOO
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 1:10025 JOHN ADAMS WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-1418
Mailing Address - Country:US
Mailing Address - Phone:407-636-3113
Mailing Address - Fax:407-636-3133
Practice Address - Street 1:430 LAKE HOWELL RD
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5907
Practice Address - Country:US
Practice Address - Phone:407-636-3113
Practice Address - Fax:407-636-3133
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2024-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME126509207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology