Provider Demographics
NPI:1053725820
Name:NANDANOOR, DHEERAJ (MD)
Entity type:Individual
Prefix:DR
First Name:DHEERAJ
Middle Name:
Last Name:NANDANOOR
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 1:2357 W MARCH LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5239
Mailing Address - Country:US
Mailing Address - Phone:209-472-2300
Mailing Address - Fax:209-472-2446
Practice Address - Street 1:2357 W MARCH LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5239
Practice Address - Country:US
Practice Address - Phone:209-472-2300
Practice Address - Fax:209-472-2446
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA153227207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program