Provider Demographics
NPI:1922069434
Name:NANAVATY, UDAY B (MD)
Entity Type:Individual
Prefix:
First Name:UDAY
Middle Name:B
Last Name:NANAVATY
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 1:700 GEIPE RD
Mailing Address - Street 2:SUITE 267 C
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4147
Mailing Address - Country:US
Mailing Address - Phone:410-747-8880
Mailing Address - Fax:410-747-8882
Practice Address - Street 1:10 SAINT PATRICKS DR
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4527
Practice Address - Country:US
Practice Address - Phone:301-705-7870
Practice Address - Fax:301-705-7628
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051119207R00000X, 207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD702000700Medicaid
DCW66210123OtherCAREFIRST
MDK519184115302OtherCAREFIRST
H07507Medicare UPIN
MDK519J086Medicare ID - Type Unspecified
MD056N902FMedicare PIN
MD056B902FMedicare PIN