Provider Demographics
NPI:1144322926
Name:NAIR, ASHALATHA KESAVANKUTTY (MD)
Entity type:Individual
Prefix:DR
First Name:ASHALATHA
Middle Name:KESAVANKUTTY
Last Name:NAIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 COLLINS AVE APT 911
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4713
Mailing Address - Country:US
Mailing Address - Phone:516-491-6880
Mailing Address - Fax:
Practice Address - Street 1:6 LODGE RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3912
Practice Address - Country:US
Practice Address - Phone:516-491-6880
Practice Address - Fax:516-482-3512
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM001411207L00000X
FLME124143207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
8K0201OtherBLUE SHIELD
AN001557OtherWORKERS COMPNO
NY02208015Medicaid
8K0201OtherBLUE SHIELD
NY02208015Medicaid