Provider Demographics
NPI:1134267719
Name:NAVA, SAMUEL NAVARATNAM (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:NAVARATNAM
Last Name:NAVA
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 1:1057 WEIRES AVE
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7437
Mailing Address - Country:US
Mailing Address - Phone:301-729-6181
Mailing Address - Fax:
Practice Address - Street 1:81 BALTIMORE ST
Practice Address - Street 2:SUITE 216
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3008
Practice Address - Country:US
Practice Address - Phone:301-777-9330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD 00236332084P0800X, 2084P2900X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Not Answered2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
6387Medicare ID - Type Unspecified
6387SNMedicare UPIN