Provider Demographics
NPI:1093071540
Name:VIJAY GROVER MD PC
Entity Type:Organization
Organization Name:VIJAY GROVER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:VIJAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:730-690-4233
Mailing Address - Street 1:14904 JEFFERSON DAVIS HWY STE 309
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3908
Mailing Address - Country:US
Mailing Address - Phone:703-690-4233
Mailing Address - Fax:703-497-4497
Practice Address - Street 1:14904 JEFFERSON DAVIS HWY STE 309
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3908
Practice Address - Country:US
Practice Address - Phone:703-690-4233
Practice Address - Fax:703-497-4497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034378207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB60205Medicare UPIN