Provider Demographics
NPI:1841394335
Name:CHOKKAVELU, VISWANATHAN (MD,FACP,FCCP)
Entity Type:Individual
Prefix:
First Name:VISWANATHAN
Middle Name:
Last Name:CHOKKAVELU
Suffix:
Gender:M
Credentials:MD,FACP,FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4290 HORSE CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-8302
Mailing Address - Country:US
Mailing Address - Phone:740-359-0337
Mailing Address - Fax:386-719-7787
Practice Address - Street 1:100 N SUGAR ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-1231
Practice Address - Country:US
Practice Address - Phone:740-695-4400
Practice Address - Fax:740-695-4148
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10800207RI0200X
FLME122458207R00000X
OH35100089207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0082979000Medicaid
OH0308723Medicaid
OH0308723Medicaid
OHA75593Medicare UPIN
WV0082979000Medicaid
WVCHO422383Medicare PIN