Provider Demographics
NPI:1689696577
Name:DORESWAMY, VINOD (MD)
Entity Type:Individual
Prefix:MR
First Name:VINOD
Middle Name:
Last Name:DORESWAMY
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 1:11011 MERIDIAN AVE N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8967
Mailing Address - Country:US
Mailing Address - Phone:206-860-4454
Mailing Address - Fax:206-860-4756
Practice Address - Street 1:11011 MERIDIAN AVE N
Practice Address - Street 2:SUITE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8967
Practice Address - Country:US
Practice Address - Phone:206-860-4454
Practice Address - Fax:206-860-4756
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47038208000000X
WAMD.60178929207K00000X
NC2008-01016208000000X
IL036.096987208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34823700Medicaid
WI023T 73-601Medicare PIN
G96922Medicare UPIN