Provider Demographics
NPI:1164777983
Name:DR D-V
Entity Type:Organization
Organization Name:DR D-V
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSHYANT
Authorized Official - Middle Name:
Authorized Official - Last Name:VISWANATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-251-6498
Mailing Address - Street 1:1 E CHASE ST
Mailing Address - Street 2:# 810
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2577
Mailing Address - Country:US
Mailing Address - Phone:818-251-6498
Mailing Address - Fax:
Practice Address - Street 1:1 E CHASE ST
Practice Address - Street 2:# 810
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2526
Practice Address - Country:US
Practice Address - Phone:818-251-6498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1041482208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========OtherEIN