Provider Demographics
NPI:1700291747
Name:MADHWANI, VIPUL (MBBS)
Entity Type:Individual
Prefix:
First Name:VIPUL
Middle Name:
Last Name:MADHWANI
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 ABRAHAM FLEXNER WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3841
Mailing Address - Country:US
Mailing Address - Phone:202-877-8278
Mailing Address - Fax:202-877-6292
Practice Address - Street 1:110 IRVING ST NW
Practice Address - Street 2:DEPARTMENT OF INTERNAL MEDICINE
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3017
Practice Address - Country:US
Practice Address - Phone:202-877-8278
Practice Address - Fax:202-877-6292
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-28
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY51519207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty