Provider Demographics
NPI:1831292200
Name:MORADIA, VIJAY J (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:J
Last Name:MORADIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4606 CLYDE MORRIS
Mailing Address - Street 2:#1L
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129
Mailing Address - Country:US
Mailing Address - Phone:386-756-9009
Mailing Address - Fax:386-756-3006
Practice Address - Street 1:4606 CLYDE MORRIS
Practice Address - Street 2:#1L
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129
Practice Address - Country:US
Practice Address - Phone:386-756-9009
Practice Address - Fax:386-756-3006
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME62606208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G12523Medicare UPIN
FL26747Medicare ID - Type Unspecified