Provider Demographics
NPI:1841216660
Name:VIRDI, MANJIT JUNEJA (MD)
Entity Type:Individual
Prefix:
First Name:MANJIT
Middle Name:JUNEJA
Last Name:VIRDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3314
Mailing Address - Country:US
Mailing Address - Phone:407-975-0681
Mailing Address - Fax:407-975-0683
Practice Address - Street 1:2340 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3314
Practice Address - Country:US
Practice Address - Phone:407-975-0681
Practice Address - Fax:407-975-0683
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42002208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067680200Medicaid
FL067680200Medicaid
FL15823ZMedicare ID - Type Unspecified