Healthcare Provider Details

I. General information

NPI: 1659301323
Provider Name (Legal Business Name): DINESH NAYAK MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 E 2ND ST
MANCHESTER OH
45144-1302
US

IV. Provider business mailing address

28 E 2ND ST
MANCHESTER OH
45144-1302
US

V. Phone/Fax

Practice location:
  • Phone: 937-549-2691
  • Fax:
Mailing address:
  • Phone: 937-549-2691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35067339N
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number35067339N
License Number StateOH

VIII. Authorized Official

Name: DINESH U NAYAK
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 937-549-2691