Provider Demographics
NPI:1003026410
Name:MUMMADI, VIJAYA (MD)
Entity Type:Individual
Prefix:
First Name:VIJAYA
Middle Name:
Last Name:MUMMADI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 N CENTRAL EXPY STE 225
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0918
Mailing Address - Country:US
Mailing Address - Phone:469-646-8880
Mailing Address - Fax:469-646-8884
Practice Address - Street 1:9900 N CENTRAL EXPY STE 225
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0918
Practice Address - Country:US
Practice Address - Phone:469-646-8880
Practice Address - Fax:469-646-8884
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086385207R00000X
FLME106499207R00000X
TXN5268207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2172397Medicaid
TX2172397Medicaid
TXTXB111534Medicare PIN
TXTXB165678Medicare PIN