Provider Demographics
NPI:1063474260
Name:NELLORE, VIJAY KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:KUMAR
Last Name:NELLORE
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 1:7 DIXIE DR
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-5410
Mailing Address - Country:US
Mailing Address - Phone:410-836-8584
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 361,VAMCHS
Practice Address - Street 2:MANAGED CARE
Practice Address - City:PERRY POINT
Practice Address - State:MD
Practice Address - Zip Code:21902
Practice Address - Country:US
Practice Address - Phone:410-642-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD21779207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology