Healthcare Provider Details

I. General information

NPI: 1932102092
Provider Name (Legal Business Name): DINESH U. NAYAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 01/08/2008
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: 937-549-3158
Mailing address:
  • Phone: 937-549-2691
  • Fax: 937-549-3158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-06-7339N
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: