Provider Demographics
NPI:1376568550
Name:SWAMINATHAN, VISWANATHAN (MD,DFAPA)
Entity Type:Individual
Prefix:DR
First Name:VISWANATHAN
Middle Name:
Last Name:SWAMINATHAN
Suffix:
Gender:M
Credentials:MD,DFAPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719.WEST 15TH. STREET ,SUITE-11
Mailing Address - Street 2:EASTCOAST PSYCHIATRIC SERVICES
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889
Mailing Address - Country:US
Mailing Address - Phone:252-974-1331
Mailing Address - Fax:252-974-1164
Practice Address - Street 1:804.WASHINGTON STREET
Practice Address - Street 2:VIDANT BEHAVIOUR HEALTH,
Practice Address - City:PLYMOUTHY
Practice Address - State:NC
Practice Address - Zip Code:27962
Practice Address - Country:US
Practice Address - Phone:252-793-1154
Practice Address - Fax:252-793-3860
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC226362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC22636OtherMEDICAL LICENSE AS A PHYS
NC8981128Medicaid
NCC85691Medicare UPIN
NC202105IMedicare ID - Type UnspecifiedNUMBER