Provider Demographics
NPI:1730200031
Name:NATHWANI, NIYATI ANAND (MD)
Entity type:Individual
Prefix:
First Name:NIYATI
Middle Name:ANAND
Last Name:NATHWANI
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 1:640 S LAKE AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-3958
Mailing Address - Country:US
Mailing Address - Phone:626-405-8929
Mailing Address - Fax:
Practice Address - Street 1:902 W MEETING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-6219
Practice Address - Country:US
Practice Address - Phone:803-329-7772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84095207RH0003X
SC29483207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC294835Medicaid
SC294835Medicaid