Provider Demographics
NPI:1912048836
Name:DEWAN, NAAKESH A (MD)
Entity Type:Individual
Prefix:
First Name:NAAKESH
Middle Name:A
Last Name:DEWAN
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:PO BOX 10701
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-7701
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-532-1325
Practice Address - Street 1:2985 DREW ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-3012
Practice Address - Country:US
Practice Address - Phone:727-754-9281
Practice Address - Fax:727-532-1325
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME880852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL48492OtherBLUE CROSS
FLK6128Medicare ID - Type Unspecified
G62874Medicare UPIN