Provider Demographics
NPI:1043395296
Name:DEWAN, SANJIV (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJIV
Middle Name:
Last Name:DEWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:3/208N
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-3133
Mailing Address - Fax:215-707-3945
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:4TH FL PARKINSON PAVILION
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-3133
Practice Address - Fax:215-707-3945
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034906E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0558554000OtherKEYSTONE HEALTH PLAN EAST
P1500506OtherOXFORD HEALTHPLAN
128217304OtherAMERICHOICE
00300OtherHEALTH PARTNERS
1000303OtherKEYSTONE MERCY
14226OtherELDER HEALTH
PA0012821730003Medicaid
5036318OtherAETNA US HEALTHCARE
P1500506OtherOXFORD HEALTHPLAN
0558554000OtherKEYSTONE HEALTH PLAN EAST