Provider Demographics
NPI:1770504490
Name:JALIGAM, VIJAYENDRA RAO (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAYENDRA
Middle Name:RAO
Last Name:JALIGAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8320 OLD COURTHOUSE RD STE 401
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3848
Mailing Address - Country:US
Mailing Address - Phone:571-470-6243
Mailing Address - Fax:
Practice Address - Street 1:8320 OLD COURTHOUSE RD STE 401
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3848
Practice Address - Country:US
Practice Address - Phone:571-470-6243
Practice Address - Fax:571-200-2617
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA027061207R00000X, 207RC0000X
VA0101278527207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1043346Medicaid
LA1043346Medicaid
LA4K019F669Medicare PIN