Healthcare Provider Details

I. General information

NPI: 1376568550
Provider Name (Legal Business Name): VISWANATHAN SWAMINATHAN M.D.,DFAPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804.WASHINGTON STREET VIDANT BEHAVIOUR HEALTH,
PLYMOUTHY NC
27962
US

IV. Provider business mailing address

719.WEST 15TH. STREET ,SUITE-11 EASTCOAST PSYCHIATRIC SERVICES
WASHINGTON NC
27889
US

V. Phone/Fax

Practice location:
  • Phone: 252-793-1154
  • Fax: 252-793-3860
Mailing address:
  • Phone: 252-974-1331
  • Fax: 252-974-1164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number22636
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: