Provider Demographics
NPI:1992854285
Name:NIMMAGADDA, VIJAYALAKSHMI (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAYALAKSHMI
Middle Name:
Last Name:NIMMAGADDA
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 1:1414 CRAIN HWY N
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-7001
Mailing Address - Country:US
Mailing Address - Phone:410-760-4465
Mailing Address - Fax:410-760-0875
Practice Address - Street 1:1414 CRAIN HWY N
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-7001
Practice Address - Country:US
Practice Address - Phone:410-760-4465
Practice Address - Fax:410-760-0875
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD022570207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6423Medicare PIN
MDB45865Medicare UPIN