Provider Demographics
NPI:1912349911
Name:NAYAK, ATMA PRAKASH (MD)
Entity Type:Individual
Prefix:
First Name:ATMA
Middle Name:PRAKASH
Last Name:NAYAK
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 1:42 HOLIDAY DR
Mailing Address - Street 2:APT#171
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5347
Mailing Address - Country:US
Mailing Address - Phone:570-991-8810
Mailing Address - Fax:
Practice Address - Street 1:2 SHARPE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3715
Practice Address - Country:US
Practice Address - Phone:570-991-8810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT204988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine