Provider Demographics
NPI:1922186659
Name:IYENGAR, PHANIRAJ (MD)
Entity Type:Individual
Prefix:
First Name:PHANIRAJ
Middle Name:
Last Name:IYENGAR
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 1:3006 S MARYLAND PKWY STE 765
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2246
Mailing Address - Country:US
Mailing Address - Phone:702-731-8115
Mailing Address - Fax:702-784-7844
Practice Address - Street 1:3006 S MARYLAND PKWY STE 765
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2246
Practice Address - Country:US
Practice Address - Phone:702-731-8115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA564692084N0400X
CT0453182084V0102X
TN679752084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology