Provider Demographics
NPI:1699868877
Name:VISWANATHAN, SRIVIDYA (MD)
Entity type:Individual
Prefix:DR
First Name:SRIVIDYA
Middle Name:
Last Name:VISWANATHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SRIVIDYA
Other - Middle Name:
Other - Last Name:VENKATAKRISHNAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1485 ROYAL OAK TRL
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-3634
Mailing Address - Country:US
Mailing Address - Phone:419-756-2310
Mailing Address - Fax:
Practice Address - Street 1:1485 ROYAL OAK TRL
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-3634
Practice Address - Country:US
Practice Address - Phone:419-756-2310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078517207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine