Provider Demographics
NPI:1184680522
Name:DAVE, NAILESH D (MD)
Entity type:Individual
Prefix:DR
First Name:NAILESH
Middle Name:D
Last Name:DAVE
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 1:350 PINE STATE STREET
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-7961
Mailing Address - Country:US
Mailing Address - Phone:910-893-9700
Mailing Address - Fax:910-893-9747
Practice Address - Street 1:350 PINE STATE ST
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-9428
Practice Address - Country:US
Practice Address - Phone:910-893-9700
Practice Address - Fax:910-893-9747
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900027174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1209MOtherBLUE CROSS BLUE SHIELD NC
NC891209MMedicaid
NC2076867OtherFIRST HEALTH
NC7638069OtherAETNA HEALTHCARE
NCG900065Medicare UPIN
NC891209MMedicaid