Provider Demographics
NPI:1083877112
Name:VEGESNA, VIJAYARAMA R (MD)
Entity Type:Individual
Prefix:
First Name:VIJAYARAMA
Middle Name:R
Last Name:VEGESNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5410 MARYLAND WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5339
Mailing Address - Country:US
Mailing Address - Phone:615-371-5744
Mailing Address - Fax:888-241-1404
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:CC262
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-3850
Practice Address - Fax:904-244-4799
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME109620207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFD691ZMedicare PIN