Provider Demographics
NPI:1275828196
Name:DEWAN, VINAY NEIL (MD)
Entity Type:Individual
Prefix:DR
First Name:VINAY
Middle Name:NEIL
Last Name:DEWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1100 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:623-878-3939
Mailing Address - Fax:623-878-5567
Practice Address - Street 1:6677 W THUNDERBIRD RD STE F101
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3723
Practice Address - Country:US
Practice Address - Phone:623-878-3939
Practice Address - Fax:623-878-5567
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011015258207R00000X
TXBP10044383207W00000X
WAMD61027558207W00000X
AZ52190207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ190677Medicare PIN