Provider Demographics
NPI:1093000689
Name:EKAMBARAM, VIJAYABHARATHI (MD)
Entity Type:Individual
Prefix:
First Name:VIJAYABHARATHI
Middle Name:
Last Name:EKAMBARAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VIJAYA
Other - Middle Name:
Other - Last Name:EKAMBARAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2191 E JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6029
Mailing Address - Country:US
Mailing Address - Phone:850-494-3953
Mailing Address - Fax:850-494-3960
Practice Address - Street 1:2191 E JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6029
Practice Address - Country:US
Practice Address - Phone:850-494-3953
Practice Address - Fax:850-494-3960
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1647002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry