1598764292 NPI number — DR. SAROJA VISWAMITRA MD

Table of content: DR. SAROJA VISWAMITRA MD (NPI 1598764292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598764292 NPI number — DR. SAROJA VISWAMITRA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VISWAMITRA
Provider First Name:
SAROJA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1598764292
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 749
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHARR
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78577-1614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-362-6680
Provider Business Mailing Address Fax Number:
956-362-6688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 E SAVANNAH AVE
Provider Second Line Business Practice Location Address:
STE 10
Provider Business Practice Location Address City Name:
MCALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78503-1727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-668-9900
Provider Business Practice Location Address Fax Number:
956-668-9902
Provider Enumeration Date:
07/15/2005

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: 208100000X , with the licence number:  J9418 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 82970X . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 126545605 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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