Provider Demographics
NPI:1417290065
Name:TANJAVUR, VIJAYAKUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAYAKUMAR
Middle Name:
Last Name:TANJAVUR
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 1:500 HART ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7504
Mailing Address - Country:US
Mailing Address - Phone:318-966-8300
Mailing Address - Fax:318-322-6530
Practice Address - Street 1:500 HART ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7504
Practice Address - Country:US
Practice Address - Phone:318-966-8300
Practice Address - Fax:318-322-6530
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3245862086S0129X
LA2966522086S0129X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY296652OtherSTATE LICENSE
LA324586OtherSTATE LICENSE