Provider Demographics
NPI:1922039528
Name:TIWARI, SALIL CHANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:SALIL
Middle Name:CHANDRA
Last Name:TIWARI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:971 LAKELAND DR
Mailing Address - Street 2:SUITE 1151
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4643
Mailing Address - Country:US
Mailing Address - Phone:601-981-0039
Mailing Address - Fax:601-981-0099
Practice Address - Street 1:971 LAKELAND DR
Practice Address - Street 2:SUITE 1151
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4643
Practice Address - Country:US
Practice Address - Phone:601-981-0039
Practice Address - Fax:601-981-0099
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS107462084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06921064Medicaid
MS06921064Medicaid