Provider Demographics
NPI:1346237104
Name:VEDERE, TANUJA TIRUNAGARI (MD)
Entity Type:Individual
Prefix:
First Name:TANUJA
Middle Name:TIRUNAGARI
Last Name:VEDERE
Suffix:
Gender:F
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 1903
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33475-1903
Mailing Address - Country:US
Mailing Address - Phone:772-335-7888
Mailing Address - Fax:772-335-0331
Practice Address - Street 1:1801 SE HILLMOOR DR
Practice Address - Street 2:C107
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7553
Practice Address - Country:US
Practice Address - Phone:772-335-7888
Practice Address - Fax:772-335-0331
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76026207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F63487Medicare UPIN
43935Medicare ID - Type Unspecified