Provider Demographics
NPI:1194791434
Name:VISWANATHAN, PERINKULAM V (MD)
Entity type:Individual
Prefix:DR
First Name:PERINKULAM
Middle Name:V
Last Name:VISWANATHAN
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 1:125 DAUGHERTY DRIVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146
Mailing Address - Country:US
Mailing Address - Phone:412-856-4666
Mailing Address - Fax:
Practice Address - Street 1:125 DAUGHERTY DR STE 301
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2749
Practice Address - Country:US
Practice Address - Phone:412-856-4666
Practice Address - Fax:412-856-6907
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD073472L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001857772Medicaid
PA0018577720007Medicaid
PAG66325Medicare UPIN