Provider Demographics
NPI:1811199672
Name:VASANTH M VISHWANATH M.D. INC
Entity Type:Organization
Organization Name:VASANTH M VISHWANATH M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEATRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MILTTHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-299-8889
Mailing Address - Street 1:7075 N MAPLE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-8014
Mailing Address - Country:US
Mailing Address - Phone:559-299-8889
Mailing Address - Fax:559-299-9944
Practice Address - Street 1:7075 N MAPLE AVE STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-8014
Practice Address - Country:US
Practice Address - Phone:559-299-8889
Practice Address - Fax:559-299-9944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG077810207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G778100Medicaid
CA00G778100Medicaid
CAF73172Medicare UPIN