Basic Information
| Provider Information | |||||||||
| NPI: | 1164861886 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NARASIMHADEVARA | ||||||||
| FirstName: | NINA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 LANARK RD APT 2 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021357886 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787613338 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2100 DORCHESTER AVE | ||||||||
| Address2: | DORCHESTER | ||||||||
| City: | DORCHESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021245615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175062726 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2013 | ||||||||
| LastUpdateDate: | 06/15/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 256253 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.