Provider Demographics
NPI:1619930617
Name:GANDHI, VIJAYKUMAR KANTILAL (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAYKUMAR
Middle Name:KANTILAL
Last Name:GANDHI
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 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:609-465-3995
Mailing Address - Fax:609-465-4913
Practice Address - Street 1:333 COTTMAN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2434
Practice Address - Country:US
Practice Address - Phone:215-728-2500
Practice Address - Fax:215-728-3639
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037018E207RX0202X
NJ25MA04454500207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1264800Medicaid
06- 1286525OtherTAXPAYER IDENTI. NUMBER
06- 1286525OtherTAXPAYER IDENTI. NUMBER