Basic Information
| Provider Information | |||||||||
| NPI: | 1700044112 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NANAVATY | ||||||||
| FirstName: | PREMA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1221 24TH ST NW | ||||||||
| Address2: | APARTMENT 1001 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200371130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306499014 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3000 GALLOWS ROAD | ||||||||
| Address2: | INOVA FAIRFAX HOSPITAL | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 20037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027154000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2008 | ||||||||
| LastUpdateDate: | 01/24/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101248458 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD038397 | DC | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.