Provider Demographics
NPI:1164519104
Name:RAMU, VIJAY KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:KUMAR
Last Name:RAMU
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:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684-0699
Mailing Address - Country:US
Mailing Address - Phone:423-439-7280
Mailing Address - Fax:423-979-4134
Practice Address - Street 1:329 N STATE OF FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6062
Practice Address - Country:US
Practice Address - Phone:423-439-7280
Practice Address - Fax:423-439-8110
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN037021207R00000X
TNMD37021207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3714470OtherGROUP MEDICARE
TN1521109Medicaid