Basic Information
Provider Information
NPI: 1184869414
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VEERARAGHAVAN
FirstName: NANDHINI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2830 EASTON AVE
Address2:  
City: BETHLEHEM
State: PA
PostalCode: 180174204
CountryCode: US
TelephoneNumber: 6109543555
FaxNumber: 6109543560
Practice Location
Address1: 2830 EASTON AVE
Address2:  
City: BETHLEHEM
State: PA
PostalCode: 180174204
CountryCode: US
TelephoneNumber: 6109543555
FaxNumber: 6109543560
Other Information
ProviderEnumerationDate: 12/16/2008
LastUpdateDate: 07/08/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207QS0010XMD432057PAY Allopathic & Osteopathic PhysiciansFamily MedicineSports Medicine

No ID Information.


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