Provider Demographics
NPI:1790746097
Name:THAMMAN, VIJAY (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:
Last Name:THAMMAN
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 1:361 GARIBALDI AVE
Mailing Address - Street 2:VIJAY THAMMAN MD
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-3709
Mailing Address - Country:US
Mailing Address - Phone:973-773-3556
Mailing Address - Fax:973-773-2337
Practice Address - Street 1:361 GARIBALDI AVE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-3709
Practice Address - Country:US
Practice Address - Phone:973-773-3556
Practice Address - Fax:973-773-2337
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25642207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2052504Medicaid
NJTH513483Medicare ID - Type Unspecified
NJ2052504Medicaid