MEDICARE: MR. NAVANEETH NAMBIA OTHAYOTH GANAPATHIYADAN MD

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
1	207Q00000X	Family Medicine Physician	74958	AZ

General Provider Information

NPI Number	:	1770202251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NAVANEETH NAMBIA OTHAYOTH GANAPATHIYADAN MD

Provider Business Mailing Address
First Line	:	1980 W HOSPITAL DR STE 209
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-7804
Country	:	US
Telephone Number	:	321-945-2704
Fax Number	:

Provider Business Practice Location Address
First Line	:	10120 E OLD VAIL RD STE 100
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-9414
Country	:	US
Telephone Number	:	520-989-8012
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2022
Last Update Date	:	08/13/2025

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