Basic Information
| Provider Information | |||||||||
| NPI: | 1972898625 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAINI | ||||||||
| FirstName: | PRATHAP | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26005 RIDGE RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | DAMASCUS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208721899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014142300 | ||||||||
| FaxNumber: | 3014140476 | ||||||||
| Practice Location | |||||||||
| Address1: | 7620 CARROLL AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | TAKOMA PARK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209126388 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018916647 | ||||||||
| FaxNumber: | 3018916654 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2011 | ||||||||
| LastUpdateDate: | 02/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD043099 | DC | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 390200000X | MT 199329 | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207V00000X | D0079635 | MD | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 101828100 | 05 | MD | MEDICAID |