Provider Demographics
NPI:1013937564
Name:NANAVATY, RAJIV B (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJIV
Middle Name:B
Last Name:NANAVATY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BURNETTS WAY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8168
Mailing Address - Country:US
Mailing Address - Phone:757-934-1900
Mailing Address - Fax:757-925-6719
Practice Address - Street 1:150 BURNETTS WAY
Practice Address - Street 2:SUITE 320
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8168
Practice Address - Country:US
Practice Address - Phone:757-934-1900
Practice Address - Fax:757-925-6719
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012304722084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA130025269OtherMEDICARE RR
VA007102925Medicaid
VAH58376Medicare UPIN
VA130025269OtherMEDICARE RR
VA015955O04Medicare PIN