Provider Demographics
NPI:1548215981
Name:PURI, VINEET (MD)
Entity Type:Individual
Prefix:
First Name:VINEET
Middle Name:
Last Name:PURI
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 1:1009 QUAIL RUN
Mailing Address - Street 2:
Mailing Address - City:CAMDEN WYOMING
Mailing Address - State:DE
Mailing Address - Zip Code:19934-9500
Mailing Address - Country:US
Mailing Address - Phone:302-698-3499
Mailing Address - Fax:
Practice Address - Street 1:1001 S BRADFORD ST
Practice Address - Street 2:STE 9
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4153
Practice Address - Country:US
Practice Address - Phone:302-744-9645
Practice Address - Fax:302-744-9649
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10005512207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001179902Medicaid
DEG00781Medicare ID - Type Unspecified
DE0001179902Medicaid