Provider Demographics
NPI:1821280207
Name:GOGINENI, VIJAYA KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAYA
Middle Name:KUMAR
Last Name:GOGINENI
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:855 A AVE NE STE 400
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5064
Mailing Address - Country:US
Mailing Address - Phone:319-363-3565
Mailing Address - Fax:319-363-4001
Practice Address - Street 1:855 A AVE NE STE 400
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5064
Practice Address - Country:US
Practice Address - Phone:319-363-3565
Practice Address - Fax:319-363-4001
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA40972207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease