Provider Demographics
NPI:1205066537
Name:PARUCHURI, VIJAYAPRAVEENA (MD)
Entity type:Individual
Prefix:DR
First Name:VIJAYAPRAVEENA
Middle Name:
Last Name:PARUCHURI
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 1:17 LANSING ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1983
Mailing Address - Country:US
Mailing Address - Phone:315-255-7011
Mailing Address - Fax:315-255-7099
Practice Address - Street 1:17 LANSING ST STE 1160
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1983
Practice Address - Country:US
Practice Address - Phone:315-567-0540
Practice Address - Fax:315-567-0334
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254091207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03879825Medicaid