=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396700274
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VERNU VISVALINGAM MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2006
-----------------------------------------------------
Last Update Date | 05/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 ERDMAN WAY
-----------------------------------------------------
City | LEOMINSTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-537-7552
-----------------------------------------------------
Fax | 978-537-7383
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 ERDMAN WAY
-----------------------------------------------------
City | LEOMINSTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-342-8892
-----------------------------------------------------
Fax | 941-342-8893
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | ME84370
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------