Provider Demographics
NPI:1043285141
Name:NAGARAJAN, VISWANATHAN (MD)
Entity Type:Individual
Prefix:
First Name:VISWANATHAN
Middle Name:
Last Name:NAGARAJAN
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 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-1479
Mailing Address - Fax:239-424-1423
Practice Address - Street 1:14192 METROPOLIS AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4331
Practice Address - Country:US
Practice Address - Phone:239-245-8223
Practice Address - Fax:239-244-9481
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207809207R00000X
FLME92706207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14C54OtherFLORIDA BLUE
FL020160600Medicaid
NY01722265Medicaid
G44170Medicare UPIN
NY01722265Medicaid
FLFD704ZMedicare PIN