Provider Demographics
NPI:1043311699
Name:NIRMALAN, NADARAJAH (MD)
Entity type:Individual
Prefix:
First Name:NADARAJAH
Middle Name:
Last Name:NIRMALAN
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:PO BOX 24535
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33623-4535
Mailing Address - Country:US
Mailing Address - Phone:727-823-2188
Mailing Address - Fax:
Practice Address - Street 1:3831 16TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-5601
Practice Address - Country:US
Practice Address - Phone:727-527-2139
Practice Address - Fax:727-522-2832
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074565207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110222047OtherRR MCR LOC 1
FL43370OtherBLUE CROSS
FL253566100Medicaid
FLP00658957OtherRR MCR LOC 2
FLP00658957OtherRR MCR LOC 2
G07378Medicare UPIN