Healthcare Provider Details

I. General information

NPI: 1255738720
Provider Name (Legal Business Name): NANDA MIN DIN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2014
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SENTARA CIR STE 201A
WILLIAMSBURG VA
23188-5716
US

IV. Provider business mailing address

400 SENTARA CIR STE 201A
WILLIAMSBURG VA
23188-5716
US

V. Phone/Fax

Practice location:
  • Phone: 757-984-3975
  • Fax: 757-510-9190
Mailing address:
  • Phone: 757-984-3975
  • Fax: 757-510-9190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0101280270
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberC1-0013744
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number0101280270
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: