Provider Demographics
NPI:1710079942
Name:TATAGARI, VIJAYASEKHAR REDDY (MD)
Entity Type:Individual
Prefix:
First Name:VIJAYASEKHAR
Middle Name:REDDY
Last Name:TATAGARI
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 1:31 GOODEN AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4143
Mailing Address - Country:US
Mailing Address - Phone:302-674-9141
Mailing Address - Fax:302-674-5907
Practice Address - Street 1:31 GOODEN AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4143
Practice Address - Country:US
Practice Address - Phone:302-674-9141
Practice Address - Fax:302-674-5907
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0004573207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001085802Medicaid
DE46823OtherCOVENTRY HEALTH CARE DE
DEG10007Medicare UPIN
DE46823OtherCOVENTRY HEALTH CARE DE