Provider Demographics
NPI:1043316656
Name:BISWAS, NANDA (MD)
Entity Type:Individual
Prefix:DR
First Name:NANDA
Middle Name:
Last Name:BISWAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12677 HESPERIA RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7735
Mailing Address - Country:US
Mailing Address - Phone:760-952-0040
Mailing Address - Fax:760-952-9163
Practice Address - Street 1:12677 HESPERIA RD
Practice Address - Street 2:SUITE 170
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7735
Practice Address - Country:US
Practice Address - Phone:760-952-0040
Practice Address - Fax:760-952-9163
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47740207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A477400Medicaid
CAA62087Medicare UPIN
CA00A477400Medicare ID - Type UnspecifiedMEDICARE