Provider Demographics
NPI:1902947062
Name:NANDHAKUMAR, AYYAVOO (MD)
Entity Type:Individual
Prefix:DR
First Name:AYYAVOO
Middle Name:
Last Name:NANDHAKUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 STONEHEDGE MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15853-9745
Mailing Address - Country:US
Mailing Address - Phone:814-772-6514
Mailing Address - Fax:
Practice Address - Street 1:1376 BUCKTAIL RD
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3212
Practice Address - Country:US
Practice Address - Phone:814-781-6565
Practice Address - Fax:814-781-1985
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047983L207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000067822OtherHIGHMARK
PA0014734060004Medicaid
PA050002703OtherRAILROAD MEDICARE
PA000067822OtherHIGHMARK