Provider Demographics
NPI:1891809968
Name:VISHWANATH, VASANTH M (MD)
Entity Type:Individual
Prefix:
First Name:VASANTH
Middle Name:M
Last Name:VISHWANATH
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 1:7075 N MAPLE AVE
Mailing Address - Street 2:102
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
Practice Address - Street 2:102
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG077810207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G778100Medicaid
CA00G778101Medicare PIN
F73172Medicare UPIN