Provider Demographics
NPI:1962643874
Name:UMA VISWANATHAN, MD PA
Entity Type:Organization
Organization Name:UMA VISWANATHAN, MD PA
Other - Org Name:UMA M. VISWANATHAN, MD PA
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAM
Authorized Official - Middle Name:
Authorized Official - Last Name:VISWANATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-245-3446
Mailing Address - Street 1:815 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-2309
Mailing Address - Country:US
Mailing Address - Phone:908-245-3446
Mailing Address - Fax:908-245-9265
Practice Address - Street 1:815 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-2309
Practice Address - Country:US
Practice Address - Phone:908-245-3446
Practice Address - Fax:908-245-9265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08394300207R00000X
NJ25MA06880000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty