Healthcare Provider Details

I. General information

NPI: 1790796852
Provider Name (Legal Business Name): SUNIL K. NAIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12201 PLUM ORCHARD DR
SILVER SPRING MD
20904-7803
US

IV. Provider business mailing address

12201 PLUM ORCHARD DR
SILVER SPRING MD
20904-7803
US

V. Phone/Fax

Practice location:
  • Phone: 301-572-1001
  • Fax: 301-572-1004
Mailing address:
  • Phone: 301-572-1001
  • Fax: 301-572-1004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME101042
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number37770
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD81121
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: