Individual
GAUTAM K VISVESWARAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
201 LYONS AVE, DIVISION OF CARDIOVASCULAR MEDICINE, NEWARK, NJ 07112-2027
(932) 926-7852
(973) 282-0839
Mailing address
201 LYONS AVE, DIVISION OF CARDIOVASCULAR MEDICINE, NEWARK, NJ 07112-2027
(932) 926-7340
(973) 926-6526
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25MA09277200
NJ
207R00000X
Internal Medicine Physician
MD446413
PA
207RI0011X
Interventional Cardiology Physician
Primary
25MA09277200
NJ
Other
Enumeration date
05/22/2009
Last updated
04/06/2023
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