Provider Demographics
NPI:1821401696
Name:NILAVAR, SUJATHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUJATHA
Middle Name:
Last Name:NILAVAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 S 13TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4100
Mailing Address - Country:US
Mailing Address - Phone:360-848-8500
Mailing Address - Fax:360-419-3700
Practice Address - Street 1:307 S 13TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4100
Practice Address - Country:US
Practice Address - Phone:360-848-8500
Practice Address - Fax:360-419-3700
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH097841207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine