Provider Demographics
NPI:1205811031
Name:KALARIA, VIJAY G (MD)
Entity type:Individual
Prefix:
First Name:VIJAY
Middle Name:G
Last Name:KALARIA
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 1:1900 MISTLETOE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4014
Mailing Address - Country:US
Mailing Address - Phone:817-338-1300
Mailing Address - Fax:817-335-9871
Practice Address - Street 1:1900 MISTLETOE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4014
Practice Address - Country:US
Practice Address - Phone:817-338-1300
Practice Address - Fax:817-335-9871
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1811207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174929301Medicaid
IN200345810Medicaid
TXG35970Medicare UPIN
TX8D7678Medicare ID - Type Unspecified
IN200345810Medicaid
TX174929301Medicaid