Provider Demographics
NPI:1871895110
Name:DONTHAMSETTI, VIKRANT (DO)
Entity type:Individual
Prefix:
First Name:VIKRANT
Middle Name:
Last Name:DONTHAMSETTI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54957-0308
Mailing Address - Country:US
Mailing Address - Phone:920-886-7300
Mailing Address - Fax:
Practice Address - Street 1:566 TOLL GATE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2716
Practice Address - Country:US
Practice Address - Phone:401-738-4800
Practice Address - Fax:401-738-8153
Is Sole Proprietor?:No
Enumeration Date:2010-11-18
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO00748207W00000X
WI68195-21207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIU400160610Medicare PIN
RIU400248081Medicare PIN