Provider Demographics
NPI:1760629240
Name:JAGADEESHAN, VINAYA KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:VINAYA
Middle Name:KUMAR
Last Name:JAGADEESHAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5410 MARYLAND WAY STE 300
Mailing Address - Street 2:COGENT HEALTHCARE, INC.
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5339
Mailing Address - Country:US
Mailing Address - Phone:615-377-5652
Mailing Address - Fax:615-377-1687
Practice Address - Street 1:2670 E 29TH ST STE A
Practice Address - Street 2:COGENT HEALTHCARE OF TEXAS, P.A.
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2501
Practice Address - Country:US
Practice Address - Phone:979-776-5967
Practice Address - Fax:979-774-4849
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2010-03-18
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Provider Licenses
StateLicense IDTaxonomies
TXN3754207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CF727OtherBC/BS
TX207446001Medicaid
TX8CF727OtherBC/BS