1376568550 NPI number — DR. VISWANATHAN SWAMINATHAN M.D.,DFAPA

Table of content: DR. VISWANATHAN SWAMINATHAN M.D.,DFAPA (NPI 1376568550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376568550 NPI number — DR. VISWANATHAN SWAMINATHAN M.D.,DFAPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWAMINATHAN
Provider First Name:
VISWANATHAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.,DFAPA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376568550
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
719.WEST 15TH. STREET ,SUITE-11
Provider Second Line Business Mailing Address:
EASTCOAST PSYCHIATRIC SERVICES
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27889
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-974-1331
Provider Business Mailing Address Fax Number:
252-974-1164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
804.WASHINGTON STREET
Provider Second Line Business Practice Location Address:
VIDANT BEHAVIOUR HEALTH,
Provider Business Practice Location Address City Name:
PLYMOUTHY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-793-1154
Provider Business Practice Location Address Fax Number:
252-793-3860
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  22636 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 22636 . This is a "MEDICAL LICENSE AS A PHYS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8981128 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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