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Individual

VASANTHA S HATHWAR

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1008 FIRST COLONIAL RD, SUITE 103, VIRGINIA BEACH, VA 23454-3071
(757) 481-2515
(757) 481-4064
Mailing address
PO BOX 7068, PORTSMOUTH, VA 23707-0068
(757) 686-3508
(757) 686-0541

Taxonomy

Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
0101232454
VA
207RP1001X
Pulmonary Disease Physician
Primary
0101232454
VA
207RS0012X
Sleep Medicine (Internal Medicine) Physician
0101232454
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
290000288
MEDICARE PTAN BEFORE 2009
VA
01
436738
BCBS
VA
01
53891
OPTIMA
VA
05
586904B
VA
Enumeration date
09/22/2006
Last updated
01/06/2012
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