Provider Demographics
NPI:1841363009
Name:NAIR, AMITA N (MD)
Entity type:Individual
Prefix:DR
First Name:AMITA
Middle Name:N
Last Name:NAIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 SARATOGA AVE.
Mailing Address - Street 2:WATERFORD HEALTH CENTER
Mailing Address - City:WATERFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12188
Mailing Address - Country:US
Mailing Address - Phone:518-233-1162
Mailing Address - Fax:518-233-0903
Practice Address - Street 1:158 SARATOGA AVE.
Practice Address - Street 2:WATERFORD HEALTH CENTER
Practice Address - City:WATERFORD
Practice Address - State:NY
Practice Address - Zip Code:12188
Practice Address - Country:US
Practice Address - Phone:518-233-1162
Practice Address - Fax:518-233-0903
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12806208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30205411Medicaid
NH30205411Medicaid
NHRE 8417Medicare ID - Type Unspecified