MEDICARE: ESWAR APPA NYAMATHI 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	2086S0129X	Vascular Surgery Physician	A40919	CA

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

General Provider Information

NPI Number	:	1528050960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESWAR APPA NYAMATHI MD

Provider Business Mailing Address
First Line	:	17075 DEVONSHIRE ST
Second Line	:	STE 106
City	:	NORTHRIDGE
State	:	CA
Zip	:	91325-1600
Country	:	US
Telephone Number	:	818-831-3287
Fax Number	:	818-831-3267

Provider Business Practice Location Address
First Line	:	17075 DEVONSHIRE ST
Second Line	:	STE 106
City	:	NORTHRIDGE
State	:	CA
Zip	:	91325-1600
Country	:	US
Telephone Number	:	818-831-3287
Fax Number	:	818-831-3267

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	04/16/2008

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