Provider Demographics
NPI:1457351942
Name:VIJAYAKUMAR, HAROHALLI RAMAKRISHNAN (MD)
Entity Type:Individual
Prefix:
First Name:HAROHALLI
Middle Name:RAMAKRISHNAN
Last Name:VIJAYAKUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 EAST ST
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-4500
Mailing Address - Country:US
Mailing Address - Phone:978-689-4601
Mailing Address - Fax:978-689-3096
Practice Address - Street 1:295 VARNUM AVE
Practice Address - Street 2:295 VARNUM AVE
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2193
Practice Address - Country:US
Practice Address - Phone:978-937-6235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71491207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
733647OtherTUFT
J09189OtherMASS. BCBS
050034799OtherRR MEDICARE
NH30005577Medicaid
MA3053610Medicaid
C71603Medicare UPIN
NH30005577Medicaid