Provider Demographics
NPI:1295750578
Name:MARWAHA, VIJAY R (MD)
Entity type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:R
Last Name:MARWAHA
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 1:750 ROUTE 73 S STE 309A
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4191
Mailing Address - Country:US
Mailing Address - Phone:856-872-3636
Mailing Address - Fax:856-872-3606
Practice Address - Street 1:750 ROUTE 73 S STE 309
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4141
Practice Address - Country:US
Practice Address - Phone:856-872-3636
Practice Address - Fax:856-872-3606
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD449336207RC0000X, 207RI0011X
VA0101232797174400000X
NJ25MA08624500207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0266281Medicaid
VA192006OtherANTHEM
VA010277205Medicaid
VA010033C23Medicare ID - Type Unspecified
VA192006OtherANTHEM
VAI51628Medicare UPIN