Provider Demographics
NPI:1184734733
Name:KATARI, VIJAY SEKHAR (MD)
Entity type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:SEKHAR
Last Name:KATARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GIRIJAPATHI
Other - Middle Name:V S
Other - Last Name:KATARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11625 CUSTER ROAD PO BOX 501
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035
Mailing Address - Country:US
Mailing Address - Phone:214-425-0254
Mailing Address - Fax:214-856-3140
Practice Address - Street 1:8680 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-3096
Practice Address - Country:US
Practice Address - Phone:214-425-0254
Practice Address - Fax:214-856-3140
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ1999207R00000X
PAMD429723207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101722504Medicaid
PA7782946OtherAETNA
MD890483OtherCAREFIRST MD BCBS
PAP006414OtherGATEWAY-WMG
PA205762OtherJOHNS HOPKINS
PA102474OtherGEISINGER
PA1891032OtherHIGHMARK BLUE SHIELD
PAP006414OtherGATEWAY-WMG
PA205762OtherJOHNS HOPKINS
PA104483Medicare PIN