Provider Demographics
NPI:1659560746
Name:B VIJAYA KUMAR MD PA
Entity Type:Organization
Organization Name:B VIJAYA KUMAR MD PA
Other - Org Name:BANGARUSWAMY VIJAYA KUMAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BANGARUSWAMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-935-8470
Mailing Address - Street 1:2206 VALLEY BLOSSUM LN
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3977
Mailing Address - Country:US
Mailing Address - Phone:361-935-8470
Mailing Address - Fax:
Practice Address - Street 1:601 E SAN ANTONIO ST
Practice Address - Street 2:SUITE 403W
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6040
Practice Address - Country:US
Practice Address - Phone:361-580-1500
Practice Address - Fax:361-580-1507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0067EWOtherBCBS
TX5252513OtherAETNA
TX097036001Medicaid
TX5252513OtherAETNA