Provider Demographics
NPI:1528019262
Name:VISWANATH, DILIP B (MD)
Entity Type:Individual
Prefix:DR
First Name:DILIP
Middle Name:B
Last Name:VISWANATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 WHITE HORSE PIKE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1927
Mailing Address - Country:US
Mailing Address - Phone:856-547-0539
Mailing Address - Fax:856-547-3178
Practice Address - Street 1:210 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1715
Practice Address - Country:US
Practice Address - Phone:856-547-0539
Practice Address - Fax:856-547-3178
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06635000207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7925701Medicaid
NJ060054326Medicare PIN
NJG58660Medicare UPIN
NJ001283BDGMedicare PIN