Provider Demographics
NPI:1811292055
Name:DEEWAN, DEEWAN (MD)
Entity type:Individual
Prefix:DR
First Name:DEEWAN
Middle Name:
Last Name:DEEWAN
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 1:1655 BERNARDIN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2044
Mailing Address - Country:US
Mailing Address - Phone:803-256-1137
Mailing Address - Fax:803-256-1138
Practice Address - Street 1:1655 BERNARDIN AVE STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2044
Practice Address - Country:US
Practice Address - Phone:803-256-1137
Practice Address - Fax:803-256-1138
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40554207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine