Provider Demographics
NPI:1730161720
Name:NATHAN, VISWA B (MD)
Entity type:Individual
Prefix:
First Name:VISWA
Middle Name:B
Last Name:NATHAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:136 SHERMAN AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4388
Mailing Address - Country:US
Mailing Address - Phone:230-946-3000
Mailing Address - Fax:203-946-3006
Practice Address - Street 1:136 SHERMAN AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4388
Practice Address - Country:US
Practice Address - Phone:230-946-3000
Practice Address - Fax:203-946-3006
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2015-05-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT022728208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001227263Medicaid
CT001227263Medicaid
CT020001114Medicare ID - Type Unspecified