1790861532 NPI number — DR. VIJAY NARASIMHA MD

Table of content: DR. VIJAY NARASIMHA MD (NPI 1790861532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790861532 NPI number — DR. VIJAY NARASIMHA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NARASIMHA
Provider First Name:
VIJAY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790861532
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 S.MOON AVE, STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRANDON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33511-5716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-681-4644
Provider Business Mailing Address Fax Number:
813-654-4486

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 PARSONS PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRANDON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33511-6066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-684-5255
Provider Business Practice Location Address Fax Number:
813-654-7457
Provider Enumeration Date:
10/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  ME78612 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2086S0129X , with the licence number: ME0078612 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 020048190 . This is a "R.R.MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01109 . This is a "UNIVERSAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 271810 . This is a "AVMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5796380 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 264791500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 49887 . This is a "BLUECROSS/BLUESHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7401818005 . This is a "CIGNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 219857 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5599677 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 264791500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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