Healthcare Provider Details

I. General information

NPI: 1346285129
Provider Name (Legal Business Name): MARIA T. NANAGAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730C VALLEY ST
DAYTON OH
45404-1958
US

IV. Provider business mailing address

4718 EAGLES NEST CIR
KETTERING OH
45429-1931
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-5355
  • Fax: 937-641-5370
Mailing address:
  • Phone: 937-293-3077
  • Fax: 937-641-5370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.038848
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: