Provider Demographics
NPI:1447488275
Name:PRAKASH-ZAWISZA, VIVEKA R (MD)
Entity type:Individual
Prefix:DR
First Name:VIVEKA
Middle Name:R
Last Name:PRAKASH-ZAWISZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VIVEKA
Other - Middle Name:P
Other - Last Name:ZAWISZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:119 BELMONT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2903
Practice Address - Country:US
Practice Address - Phone:508-334-6388
Practice Address - Fax:508-334-6344
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA250333207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110093733AMedicaid