Basic Information
| Provider Information | |||||||||
| NPI: | 1609865195 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DHAWAN | ||||||||
| FirstName: | VIKRAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 E 95TH ST | ||||||||
| Address2: | APT 17M | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 101284000 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 GUSTAVE L. LEVY PLACE | ||||||||
| Address2: | MOUNT SINAI MEDICAL CENTER | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100296574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122418867 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2005 | ||||||||
| LastUpdateDate: | 10/01/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 268699 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207R00000X | 35085862 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207L00000X | 35.085862 | OH | N | Allopathic & Osteopathic Physicians | Anesthesiology | 2084N0008X | 35.085862 | OH | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neuromuscular Medicine | 2084N0400X | 35.085862 | OH | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | P00856985 | 01 | OH | MEDICARE RAILROAD | OTHER | 7569757 | 01 | OH | AETNA | OTHER | 000000559866 | 01 | OH | ANTHEM | OTHER | 2622193 | 05 | OH | MEDICAID | 1609865195 | 05 | MI | MEDICAID |