Healthcare Provider Details

I. General information

NPI: 1013126440
Provider Name (Legal Business Name): ABHILASH P NAMBIAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4611 E SHEA BLVD STE 120
PHOENIX AZ
85028-4255
US

IV. Provider business mailing address

4611 E SHEA BLVD STE 120
PHOENIX AZ
85028-4255
US

V. Phone/Fax

Practice location:
  • Phone: 602-441-3845
  • Fax:
Mailing address:
  • Phone: 602-441-3845
  • Fax: 602-464-9769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number247548
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number50323
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number4301082079
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: