Provider Demographics
NPI:1225265176
Name:JARSANIA, VIJAYKUMAR RAMNIKLAL (MD)
Entity Type:Individual
Prefix:
First Name:VIJAYKUMAR
Middle Name:RAMNIKLAL
Last Name:JARSANIA
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 1:3041 DANIEL PLACE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213
Mailing Address - Country:US
Mailing Address - Phone:704-999-6198
Mailing Address - Fax:
Practice Address - Street 1:10035 PARK CEDAR DR STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8910
Practice Address - Country:US
Practice Address - Phone:704-999-6198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT195232207Q00000X
NC2012-01969208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5921967Medicaid
NC5921967Medicaid