Provider Demographics
NPI:1447244488
Name:NANJUNDAPPA, ARAVINDA (MD)
Entity type:Individual
Prefix:DR
First Name:ARAVINDA
Middle Name:
Last Name:NANJUNDAPPA
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 1:4675 CORNELL RD STE 150
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45241-2498
Mailing Address - Country:US
Mailing Address - Phone:513-824-6924
Mailing Address - Fax:513-824-6925
Practice Address - Street 1:306 STANAFORD RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3142
Practice Address - Country:US
Practice Address - Phone:304-255-3000
Practice Address - Fax:304-388-8238
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200501121207RC0000X
WV22960207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810010572Medicaid
NC1397AOtherBCBS NC
NC1397AOtherBCBS NC
NC2043782Medicare ID - Type Unspecified