Provider Demographics
NPI:1659698025
Name:VIJAYAN CHARLES, MD PA
Entity Type:Organization
Organization Name:VIJAYAN CHARLES, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VIJAYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-982-4892
Mailing Address - Street 1:7237 HANOVER PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3602
Mailing Address - Country:US
Mailing Address - Phone:301-982-4892
Mailing Address - Fax:301-982-5813
Practice Address - Street 1:7237 HANOVER PKWY STE B
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3602
Practice Address - Country:US
Practice Address - Phone:301-982-4892
Practice Address - Fax:301-982-5813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB94159Medicare UPIN
DC177471Medicare PIN