Healthcare Provider Details

I. General information

NPI: 1013016062
Provider Name (Legal Business Name): VICTOR N NANAGAS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE CHILDRENS PLAZA STE 2071
DAYTON OH
45404
US

IV. Provider business mailing address

4718 EAGLES NEST CIRCLE
KETTERING OH
45429
US

V. Phone/Fax

Practice location:
  • Phone: 937-461-5020
  • Fax: 937-641-3107
Mailing address:
  • Phone: 937-293-3077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number35038754
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: