Basic Information
Provider Information
NPI: 1164885893
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NAITHANI
FirstName: NEHA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MBBS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 509 MED TECH PKWY STE 100
Address2:  
City: JOHNSON CITY
State: TN
PostalCode: 376042579
CountryCode: US
TelephoneNumber: 4233026565
FaxNumber:  
Practice Location
Address1: 400 N STATE OF FRANKLIN RD RM 2746
Address2:  
City: JOHNSON CITY
State: TN
PostalCode: 376046035
CountryCode: US
TelephoneNumber: 4234316111
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/31/2016
LastUpdateDate: 09/21/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/05/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0200X63016TNY Allopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine

No ID Information.


Home