=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972898625
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PRATHAP R NAINI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2011
-----------------------------------------------------
Last Update Date | 02/04/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7620 CARROLL AVE STE 201
-----------------------------------------------------
City | TAKOMA PARK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20912-6388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-891-6647
-----------------------------------------------------
Fax | 301-891-6654
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26005 RIDGE RD STE 200
-----------------------------------------------------
City | DAMASCUS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20872-1899
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-414-2300
-----------------------------------------------------
Fax | 301-414-0476
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | MD043099
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number | MT 199329
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | D0079635
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------