Provider Demographics
NPI:1649290404
Name:RUPANAGUDI, VIJAY A (MD)
Entity type:Individual
Prefix:
First Name:VIJAY
Middle Name:A
Last Name:RUPANAGUDI
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 1:135 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2478
Mailing Address - Country:US
Mailing Address - Phone:931-202-3694
Mailing Address - Fax:833-944-0207
Practice Address - Street 1:135 W 3RD ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2478
Practice Address - Country:US
Practice Address - Phone:931-202-3697
Practice Address - Fax:833-944-0207
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45978207RP1001X
TNMD45978207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1520062Medicaid
TN4267428OtherBCBS
KY7100187270Medicaid
TNQ059015Medicaid
TN4267428OtherBCBS