Provider Demographics
NPI:1598764292
Name:VISWAMITRA, SAROJA (MD)
Entity type:Individual
Prefix:DR
First Name:SAROJA
Middle Name:
Last Name:VISWAMITRA
Suffix:
Gender:F
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 749
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1614
Mailing Address - Country:US
Mailing Address - Phone:956-362-6680
Mailing Address - Fax:956-362-6688
Practice Address - Street 1:1200 E SAVANNAH AVE
Practice Address - Street 2:STE 10
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1727
Practice Address - Country:US
Practice Address - Phone:956-668-9900
Practice Address - Fax:956-668-9902
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9418208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82970XOtherBLUE CROSS BLUE SHIELD
TX126545605Medicaid
TX84831NMedicare PIN