Provider Demographics
NPI:1619919230
Name:DHOOPATI, VIJAY R (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:R
Last Name:DHOOPATI
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:PO BOX 61418
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27715-1418
Mailing Address - Country:US
Mailing Address - Phone:919-471-2910
Mailing Address - Fax:919-467-1855
Practice Address - Street 1:911 RIDGE RD
Practice Address - Street 2:STE D
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-4574
Practice Address - Country:US
Practice Address - Phone:919-467-7528
Practice Address - Fax:919-467-1855
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9801236207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC135JVOtherBCBS NC INDIV NO
NC89135JVMedicaid
NC89136CFMedicaid
NC2265991CMedicare PIN
NC89136CFMedicaid