=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386625754
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GEETHA NARAYAN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2005
-----------------------------------------------------
Last Update Date | 01/15/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3230 BEARD RD SUITE 1
-----------------------------------------------------
City | NAPA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94558-3673
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-253-7005
-----------------------------------------------------
Fax | 707-253-7271
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 54 HAHNEMANN LN
-----------------------------------------------------
City | NAPA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94558-7208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-413-2705
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | 43466
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------