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NPI Code Detail

MEDICARE: DR. RAJIDIVYA VISWANATHAN MD

MEDICARE: DR. RAJIDIVYA VISWANATHAN 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
12080P0202XPediatric Cardiology Physician76670AZ

General Provider Information

NPI Number : 1154883197
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RAJIDIVYA VISWANATHAN MD
Provider Business Mailing Address
First Line : 2108 E THOMAS RD STE 130
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-0008
Country : US
Telephone Number : 602-923-3312
Fax Number :
Provider Business Practice Location Address
First Line : 1919 E THOMAS RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-7710
Country : US
Telephone Number : 602-933-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2019
Last Update Date : 01/28/2026

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