Basic Information
| Provider Information | |||||||||
| NPI: | 1134267719 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAVA | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | NAVARATNAM | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1057 WEIRES AVE | ||||||||
| Address2: | |||||||||
| City: | LAVALE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215027437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017296181 | ||||||||
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| Practice Location | |||||||||
| Address1: | 81 BALTIMORE ST | ||||||||
| Address2: | SUITE 216 | ||||||||
| City: | CUMBERLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215023008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017779330 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | D 0023633 | MD | X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P2900X | D 0023633 | MD | X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Pain Medicine | 2084S0012X | D 0023633 | MD | X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Sleep Medicine |
No ID Information.