Provider Demographics
NPI:1356365936
Name:ASHWIN L. NANAVATI MD, FACS, LLC
Entity type:Organization
Organization Name:ASHWIN L. NANAVATI MD, FACS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHWIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:NANAVATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-553-6130
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-0727
Mailing Address - Country:US
Mailing Address - Phone:410-553-6130
Mailing Address - Fax:410-553-6131
Practice Address - Street 1:7845 OAKWOOD RD
Practice Address - Street 2:SUITE #201
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:410-553-6130
Practice Address - Fax:410-553-6131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD27565208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1109OtherBLUECHOICE MARYLAND GRP #
MD406406200Medicaid
MD8029ASOtherCAREFIRST MARYLAND GRP #
MD406406200Medicaid
MDB66855Medicare UPIN