Provider Demographics
NPI:1679808190
Name:VIVEK, MEGHANA (MD)
Entity type:Individual
Prefix:
First Name:MEGHANA
Middle Name:
Last Name:VIVEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEGHANA
Other - Middle Name:
Other - Last Name:GOPAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3600 LIND AVE SW STE 100
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4970
Mailing Address - Country:US
Mailing Address - Phone:425-228-3440
Mailing Address - Fax:
Practice Address - Street 1:400 S 43RD ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5714
Practice Address - Country:US
Practice Address - Phone:425-228-3440
Practice Address - Fax:425-656-4217
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60616121207R00000X, 208M00000X, 208M00000X
AZ45060208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2050316Medicaid
WA2050316Medicaid