Provider Demographics
NPI:1881613586
Name:VERMA, VISHAL (MD)
Entity type:Individual
Prefix:DR
First Name:VISHAL
Middle Name:
Last Name:VERMA
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 1:13280 EVENING CREEK DR S STE 225
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4664
Mailing Address - Country:US
Mailing Address - Phone:888-910-0623
Mailing Address - Fax:888-630-5711
Practice Address - Street 1:13280 EVENING CREEK DR S
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4101
Practice Address - Country:US
Practice Address - Phone:858-752-9735
Practice Address - Fax:888-630-5711
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL95332085R0202X
VA0101252002208D00000X
CAA817602085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
H83076Medicare UPIN