Provider Demographics
NPI:1770202251
Name:GANAPATHIYADAN, NAVANEETH NAMBIA OTHAYOTH (MD)
Entity type:Individual
Prefix:MR
First Name:NAVANEETH
Middle Name:NAMBIA OTHAYOTH
Last Name:GANAPATHIYADAN
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 1:1980 W HOSPITAL DR STE 209
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-7804
Mailing Address - Country:US
Mailing Address - Phone:321-945-2704
Mailing Address - Fax:
Practice Address - Street 1:10120 E OLD VAIL RD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-9414
Practice Address - Country:US
Practice Address - Phone:520-989-8012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ74958207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine