Provider Demographics
NPI:1669612057
Name:DWIBHASHI, VIJAYA L (MD)
Entity type:Individual
Prefix:
First Name:VIJAYA
Middle Name:L
Last Name:DWIBHASHI
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:PO BOX 723
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-0723
Mailing Address - Country:US
Mailing Address - Phone:281-394-0093
Mailing Address - Fax:281-371-0121
Practice Address - Street 1:9555 SPRING GREEN BLVD STE H
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7940
Practice Address - Country:US
Practice Address - Phone:281-394-0093
Practice Address - Fax:281-371-0121
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN3624207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine