Provider Demographics
NPI:1932263993
Name:BOYELLA, VIJAYA D (MD)
Entity Type:Individual
Prefix:
First Name:VIJAYA
Middle Name:D
Last Name:BOYELLA
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 1:1722 PINE ST STE 503
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1160
Mailing Address - Country:US
Mailing Address - Phone:334-293-8736
Mailing Address - Fax:334-293-8738
Practice Address - Street 1:1722 PINE ST STE 204
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1158
Practice Address - Country:US
Practice Address - Phone:334-293-6825
Practice Address - Fax:334-293-6826
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35086207R00000X
NY239048207R00000X
ALMD34692207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWCKMGMedicare UPIN
AZI68925Medicare UPIN