Provider Demographics
NPI:1164572210
Name:VISHVANATH, PRAMILA (ND)
Entity Type:Individual
Prefix:MS
First Name:PRAMILA
Middle Name:
Last Name:VISHVANATH
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 POST RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5656
Mailing Address - Country:US
Mailing Address - Phone:203-259-2700
Mailing Address - Fax:203-259-3214
Practice Address - Street 1:2324 POST RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5656
Practice Address - Country:US
Practice Address - Phone:203-259-2700
Practice Address - Fax:203-259-3214
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000132175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP414403OtherOXFORD HEATH PLAN ID
CT110000132CT01OtherANTHEM PROVIDER ID
CT0R2277OtherHEALTHNET PROVIDER NUMBER