Provider Demographics
NPI:1093343352
Name:TALLAVAJHALA, VINAYKUMAR SAI (MD)
Entity Type:Individual
Prefix:
First Name:VINAYKUMAR
Middle Name:SAI
Last Name:TALLAVAJHALA
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 1:2451 UNIVERSITY HOSPITAL DR RM 714
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36617-2300
Mailing Address - Country:US
Mailing Address - Phone:251-471-7117
Mailing Address - Fax:251-445-8249
Practice Address - Street 1:2451 UNIVERSITY HOSPITAL DR RM 714
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2300
Practice Address - Country:US
Practice Address - Phone:251-660-5108
Practice Address - Fax:251-445-8249
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL390200000X
AL437302084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program