Provider Demographics
NPI:1952324311
Name:LINGAM, DIWAKAR V (MD)
Entity Type:Individual
Prefix:
First Name:DIWAKAR
Middle Name:V
Last Name:LINGAM
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 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-653-3305
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL PLAZA DR STE 175
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3049
Practice Address - Country:US
Practice Address - Phone:603-653-3305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002662207R00000X, 208M00000X
NH17114208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP01124268OtherRR MEDICARE PTAN
NY02792556Medicaid
NYP00342649Medicare PIN
NYP00670870Medicare PIN
NYRB1016Medicare PIN
NYP01124268OtherRR MEDICARE PTAN
NYRB1500Medicare PIN