MEDICARE: VISWANATHAN NAGARAJAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME92706	FL
2	207R00000X	Internal Medicine Physician	207809	NY
3	207RI0200X	Infectious Disease Physician	ME92706	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	14C54	OTHER	FL	FLORIDA BLUE

General Provider Information

NPI Number	:	1043285141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VISWANATHAN NAGARAJAN MD

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-424-1479
Fax Number	:	239-424-1423

Provider Business Practice Location Address
First Line	:	14192 METROPOLIS AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4331
Country	:	US
Telephone Number	:	239-245-8223
Fax Number	:	239-244-9481

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	11/01/2024

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