Provider Demographics
NPI:1669421681
Name:VISWAMITRA, SANJAYA (MD)
Entity type:Individual
Prefix:
First Name:SANJAYA
Middle Name:
Last Name:VISWAMITRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 W MARKHAM ST
Mailing Address - Street 2:UNIVERSITY OF ARKANSAS, DEPT OF RADIOLOGY
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-686-6902
Mailing Address - Fax:501-686-6900
Practice Address - Street 1:4301 W MARKHAM ST
Practice Address - Street 2:UNIVERSITY OF ARKANSAS, DEPT OF RADIOLOGY
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-6902
Practice Address - Fax:501-686-6900
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-27322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H27523Medicare UPIN
AR5L698Medicare ID - Type Unspecified