Provider Demographics
NPI:1972882207
Name:MALLER, VINOD GOVINDARAJ (MD)
Entity Type:Individual
Prefix:
First Name:VINOD
Middle Name:GOVINDARAJ
Last Name:MALLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:850 POPLAR AVE BLDG 2
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-4607
Mailing Address - Country:US
Mailing Address - Phone:901-287-5674
Mailing Address - Fax:901-287-6804
Practice Address - Street 1:848 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2816
Practice Address - Country:US
Practice Address - Phone:901-287-7337
Practice Address - Fax:901-287-6042
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN545342085R0204X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology