Provider Demographics
NPI:1295702066
Name:DEWAN, SANJEEV (MD)
Entity type:Individual
Prefix:
First Name:SANJEEV
Middle Name:
Last Name:DEWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 S SAWBURG RD
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-3515
Mailing Address - Country:US
Mailing Address - Phone:330-823-1680
Mailing Address - Fax:330-823-3831
Practice Address - Street 1:985 S SAWBURG RD
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-3515
Practice Address - Country:US
Practice Address - Phone:330-823-1680
Practice Address - Fax:330-823-3831
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.061557207WX0110X
OH35061557207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0850280Medicaid
OH0850280Medicaid
0693555Medicare ID - Type Unspecified