Healthcare Provider Details

I. General information

NPI: 1396700274
Provider Name (Legal Business Name): VERNU VISVALINGAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 05/08/2025
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 ERDMAN WAY
LEOMINSTER MA
01453
US

IV. Provider business mailing address

105 ERDMAN WAY
LEOMINSTER MA
01453
US

V. Phone/Fax

Practice location:
  • Phone: 978-537-7552
  • Fax: 978-537-7383
Mailing address:
  • Phone: 941-342-8892
  • Fax: 941-342-8893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME84370
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: