Provider Demographics
NPI:1336405000
Name:NANNAPANENI, NAVEEN
Entity Type:Individual
Prefix:MR
First Name:NAVEEN
Middle Name:
Last Name:NANNAPANENI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LANCASTER AVE., SUITE 237 WEST
Mailing Address - Street 2:LANKENAU MEDICAL BUILDING
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3451
Mailing Address - Country:US
Mailing Address - Phone:610-649-9300
Mailing Address - Fax:610-896-4617
Practice Address - Street 1:100 E LANCASTER AVE., SUITE 237 WEST
Practice Address - Street 2:LANKENAU MEDICAL BUILDING
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096
Practice Address - Country:US
Practice Address - Phone:610-649-9300
Practice Address - Fax:610-896-4617
Is Sole Proprietor?:No
Enumeration Date:2012-04-07
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD463396207R00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine