Healthcare Provider Details

I. General information

NPI: 1013937564
Provider Name (Legal Business Name): RAJIV B NANAVATY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BURNETTS WAY SUITE 320
SUFFOLK VA
23434-8168
US

IV. Provider business mailing address

150 BURNETTS WAY SUITE 320
SUFFOLK VA
23434-8168
US

V. Phone/Fax

Practice location:
  • Phone: 757-934-1900
  • Fax: 757-925-6719
Mailing address:
  • Phone: 757-934-1900
  • Fax: 757-925-6719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101230472
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: