Provider Demographics
NPI:1619915246
Name:DHARNIDHARKA, VIKAS RAMNATH (MD)
Entity type:Individual
Prefix:DR
First Name:VIKAS
Middle Name:RAMNATH
Last Name:DHARNIDHARKA
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 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-454-6043
Mailing Address - Fax:888-463-6898
Practice Address - Street 1:89 FRENCH ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1935
Practice Address - Country:US
Practice Address - Phone:732-235-7400
Practice Address - Fax:888-463-6898
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012018715208000000X, 2080P0210X
NJ25MA124439002080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA12443900OtherNJ LICNESE
MO209856707Medicaid