Basic Information
Provider Information
NPI: 1003297086
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NANAVATI
FirstName: ASHNOO
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2938 BRIDGEHAMPTON CT
Address2:  
City: FALLS CHURCH
State: VA
PostalCode: 220424481
CountryCode: US
TelephoneNumber: 8486679989
FaxNumber:  
Practice Location
Address1: 3300 GALLOWS RD
Address2:  
City: FALLS CHURCH
State: VA
PostalCode: 220423307
CountryCode: US
TelephoneNumber: 7037763626
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/15/2015
LastUpdateDate: 07/02/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/02/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800X0101267091VAY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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