Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 207809 | NY |
N | 111NI0900X | Internist | 207809 | NY |
Y | 207R00000X | Internist | ME92706 | FL |
Y | 111NI0900X | Internist | ME92706 | FL |
N | 207RI0200X | Infectious Disease | ME92706 | FL |
NPI | 1043285141 |
---|---|
Provider Name | Viswanathan Nagarajan |
First Address | Fort Myers, FL 33902-2147 |
Second Address | Fort Myers, FL 33912-4331 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 14/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01722265 | (05) | NY |
020160600 | (05) | FL |
14C54 | FLORIDA BLUE (01) | FL |
G44170 | (02) |