Provider Demographics
NPI:1861550592
Name:NATHAN, PADMINI (OD)
Entity type:Individual
Prefix:
First Name:PADMINI
Middle Name:
Last Name:NATHAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 THOMAS JOHNSON DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4301
Mailing Address - Country:US
Mailing Address - Phone:301-662-1601
Mailing Address - Fax:301-695-9149
Practice Address - Street 1:73 THOMAS JOHNSON DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4301
Practice Address - Country:US
Practice Address - Phone:301-662-1601
Practice Address - Fax:301-695-9149
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0842152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD456L284CMedicare UPIN
MDU09566Medicare UPIN