Provider Demographics
NPI:1629077391
Name:WADHWA, ARVIND K (MD)
Entity Type:Individual
Prefix:DR
First Name:ARVIND
Middle Name:K
Last Name:WADHWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:N TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-4631
Mailing Address - Country:US
Mailing Address - Phone:716-693-3344
Mailing Address - Fax:716-693-2448
Practice Address - Street 1:273 DIVISION ST
Practice Address - Street 2:
Practice Address - City:N TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-4631
Practice Address - Country:US
Practice Address - Phone:716-693-3344
Practice Address - Fax:716-693-2448
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168079207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01075516Medicaid
NY01075516Medicaid
NYRB3312Medicare PIN
D01505Medicare UPIN