Provider Demographics
NPI:1295165298
Name:NIMALI FERNANDO MD PLC
Entity type:Organization
Organization Name:NIMALI FERNANDO MD PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NIMALI
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-369-3316
Mailing Address - Street 1:10482 GEORGETOWN DR
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553-1748
Mailing Address - Country:US
Mailing Address - Phone:540-369-3316
Mailing Address - Fax:540-369-3317
Practice Address - Street 1:10482 GEORGETOWN DR
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22553-1748
Practice Address - Country:US
Practice Address - Phone:540-369-3316
Practice Address - Fax:540-369-3317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty