Provider Demographics
NPI:1780670075
Name:FERNANDO, NIMALI E (MD)
Entity Type:Individual
Prefix:DR
First Name:NIMALI
Middle Name:E
Last Name:FERNANDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10482 GEORGETOWN DR
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553-1748
Mailing Address - Country:US
Mailing Address - Phone:540-369-3316
Mailing Address - Fax:540-369-3317
Practice Address - Street 1:10482 GEORGETOWN DR
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22553-1748
Practice Address - Country:US
Practice Address - Phone:540-369-3316
Practice Address - Fax:540-369-3317
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2013-11-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101237959208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics