Provider Demographics
NPI:1639121353
Name:NARAYANA, ASHWATHA (MD)
Entity Type:Individual
Prefix:
First Name:ASHWATHA
Middle Name:
Last Name:NARAYANA
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 1:77 LAFAYETTE PL
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-5426
Mailing Address - Country:US
Mailing Address - Phone:203-863-3773
Mailing Address - Fax:293-863-3723
Practice Address - Street 1:77 LAFAYETTE PL
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5426
Practice Address - Country:US
Practice Address - Phone:203-863-3773
Practice Address - Fax:293-863-3723
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2255032085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G85878Medicare UPIN
NY2077E1Medicare ID - Type Unspecified