Provider Demographics
NPI:1861466963
Name:VAISHAMPAYAN, NITIN GANGADHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:NITIN
Middle Name:GANGADHAR
Last Name:VAISHAMPAYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1189
Mailing Address - Country:US
Mailing Address - Phone:248-581-5974
Mailing Address - Fax:248-581-5640
Practice Address - Street 1:4100 JOHN R ST
Practice Address - Street 2:GERSHENSON RADIATION ONCOLOGY CTR
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2013
Practice Address - Country:US
Practice Address - Phone:800-527-6266
Practice Address - Fax:313-576-9640
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2016-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010579352085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI111209OtherCARE CHOICES HMO PROV. #
MI4204199Medicaid
MI104179OtherGREAT LAKES HEALTH PLAN (AOAM)
MI104174OtherGREAT LAKES HEALTH PLAN (X-RAY)
MI4254010Medicaid
MI4254010Medicaid
MIOF36434013Medicare PIN
MI104174OtherGREAT LAKES HEALTH PLAN (X-RAY)
MI104179OtherGREAT LAKES HEALTH PLAN (AOAM)
OF36434013Medicare PIN