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NPI Code Detail

MEDICARE: DR. DEEPA NAYAK M.D.

MEDICARE: DR. DEEPA NAYAK M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician2011-01407NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427211762
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DEEPA NAYAK M.D.
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1236 GUILFORD COLLEGE ROAD
Second Line : SUITE 117
City : JAMESTOWN
State : NC
Zip : 27282-9875
Country : US
Telephone Number : 336-299-3161
Fax Number : 336-299-3180
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2008
Last Update Date : 12/23/2021

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