Provider Demographics
NPI:1790861532
Name:NARASIMHA, VIJAY (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:
Last Name:NARASIMHA
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 1:205 S.MOON AVE, STE 102
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5716
Mailing Address - Country:US
Mailing Address - Phone:813-681-4644
Mailing Address - Fax:813-654-4486
Practice Address - Street 1:116 PARSONS PARK DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6066
Practice Address - Country:US
Practice Address - Phone:813-684-5255
Practice Address - Fax:813-654-7457
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78612208600000X
FLME00786122086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
020048190OtherR.R.MEDICARE
01109OtherUNIVERSAL
271810OtherAVMED
5796380OtherGHI
FL264791500Medicaid
49887OtherBLUECROSS/BLUESHIELD
7401818005OtherCIGNA HMO
219857OtherAMERIGROUP
5599677OtherAETNA
5796380OtherGHI
FL264791500Medicaid