Provider Demographics
NPI:1013126440
Name:NAMBIAR, ABHILASH P (MD)
Entity Type:Individual
Prefix:DR
First Name:ABHILASH
Middle Name:P
Last Name:NAMBIAR
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 1:4611 E SHEA BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-4255
Mailing Address - Country:US
Mailing Address - Phone:602-441-3845
Mailing Address - Fax:602-464-9769
Practice Address - Street 1:4611 E SHEA BLVD STE 120
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-4255
Practice Address - Country:US
Practice Address - Phone:602-441-3845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2475482085R0001X
AZ503232085R0001X
MI43010820792085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02953235Medicaid
AZ9511141OtherAETNA
AZ011504Medicaid
AZ6531OtherMERCY CARE PLAN
FLP01508278OtherRAILROAD MEDICARE
AZ3127628OtherCIGNA
NY02953235Medicaid
FLP01508278OtherRAILROAD MEDICARE