Provider Demographics
NPI:1407189681
Name:DIDWANIYA, NEHA (MD)
Entity Type:Individual
Prefix:DR
First Name:NEHA
Middle Name:
Last Name:DIDWANIYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 NE 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-4896
Mailing Address - Country:US
Mailing Address - Phone:360-882-2778
Mailing Address - Fax:360-604-1682
Practice Address - Street 1:709 NE 136TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6919
Practice Address - Country:US
Practice Address - Phone:360-882-2778
Practice Address - Fax:360-604-1682
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-06
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD162495207R00000X
WAMD60675906207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500659122Medicaid
WA2068124Medicaid
OR161133OtherGROUP MEDICAID NORTH BEND MEDICAL CENTER
ORR0000WFBTVOtherGROUP MEDICARE NORTH BEND MEDICAL CENTER
ORP01228479OtherRAILROAD MEDICARE
OR500659122Medicaid
ORR170945Medicare PIN
ORR170945Medicare PIN