Provider Demographics
NPI:1801900584
Name:NARAYANAN, VINODH (MD)
Entity type:Individual
Prefix:DR
First Name:VINODH
Middle Name:
Last Name:NARAYANAN
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:PO BOX 39385
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85069-9385
Mailing Address - Country:US
Mailing Address - Phone:602-406-6380
Mailing Address - Fax:602-406-4067
Practice Address - Street 1:3330 N 2ND ST STE 402
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012
Practice Address - Country:US
Practice Address - Phone:602-687-8555
Practice Address - Fax:602-406-4067
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ311012084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ784365Medicaid
AZC57753Medicare UPIN
AZ784365Medicaid