Healthcare Provider Details

I. General information

NPI: 1003834433
Provider Name (Legal Business Name): ANIL K NAIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 MILLER ST 4TH FLOOR
QUINCY MA
02169-4725
US

IV. Provider business mailing address

173 FOREST ST
WINCHESTER MA
01890-1055
US

V. Phone/Fax

Practice location:
  • Phone: 617-639-5006
  • Fax: 617-934-2425
Mailing address:
  • Phone: 617-639-5006
  • Fax: 617-934-2425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number46924
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number46056
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number230181
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: