Provider Demographics
NPI:1366629628
Name:V.P. NAGARAJAN, M.D.
Entity Type:Organization
Organization Name:V.P. NAGARAJAN, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SLAVINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-592-7779
Mailing Address - Street 1:12202 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-2631
Mailing Address - Country:US
Mailing Address - Phone:352-592-7779
Mailing Address - Fax:352-592-7677
Practice Address - Street 1:12202 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-2630
Practice Address - Country:US
Practice Address - Phone:352-592-7779
Practice Address - Fax:352-592-7677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30767208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069305700Medicaid
340001288OtherRAIL ROAD MEDICARE
FL26072OtherBC/BS FL
FLD53346Medicare UPIN
340001288OtherRAIL ROAD MEDICARE
FLK1229Medicare PIN