Provider Demographics
NPI:1811570757
Name:PADMANABHA, NANDAN (MBBS)
Entity Type:Individual
Prefix:
First Name:NANDAN
Middle Name:
Last Name:PADMANABHA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:NANDAN
Other - Middle Name:
Other - Last Name:P
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:330 BROOKLINE AVE RM ES112
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 BROOKLINE AVE RM ES112
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-4344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program