Healthcare Provider Details

I. General information

NPI: 1619171600
Provider Name (Legal Business Name): GEETA NATHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3142 BRAMBLETON AVE
ROANOKE VA
24018-3727
US

IV. Provider business mailing address

440 MONTICELLO AVE STE 1802
NORFOLK VA
23510-2670
US

V. Phone/Fax

Practice location:
  • Phone: 540-300-5448
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101247022
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: