Provider Demographics
NPI:1932102092
Name:NAYAK, DINESH U (MD)
Entity Type:Individual
Prefix:
First Name:DINESH
Middle Name:U
Last Name:NAYAK
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 1:28 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45144-1302
Mailing Address - Country:US
Mailing Address - Phone:937-549-2691
Mailing Address - Fax:937-549-3158
Practice Address - Street 1:28 E 2ND ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45144-1302
Practice Address - Country:US
Practice Address - Phone:937-549-2691
Practice Address - Fax:937-549-3158
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-7339N207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0118643Medicaid
OH000000209652OtherANTHEM
OH67339OtherCHOICE CARE
OH31179353200OtherBWC
OH31179353200OtherBWC
OH000000209652OtherANTHEM