Provider Demographics
NPI:1336523018
Name:PADMAJA NAIR, MINI
Entity Type:Individual
Prefix:
First Name:MINI
Middle Name:
Last Name:PADMAJA NAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 S PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-7001
Mailing Address - Country:US
Mailing Address - Phone:408-660-7363
Mailing Address - Fax:
Practice Address - Street 1:2065 S PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-7001
Practice Address - Country:US
Practice Address - Phone:408-660-7363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401418629122300000X, 1223G0001X
MADL12512122300000X
MADL15099122300000X
MA15099122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0401418629OtherCOMMON WEALTH OF VIRGINIA
MAE042791396OtherBERKSIRE MEDICAL CENTER