Provider Demographics
NPI:1154736270
Name:NEELAM, VIJAY
Entity type:Individual
Prefix:
First Name:VIJAY
Middle Name:
Last Name:NEELAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9745 SUMMER GLENN AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-6189
Mailing Address - Country:US
Mailing Address - Phone:225-252-8349
Mailing Address - Fax:
Practice Address - Street 1:3600 FLORIDA BLVD
Practice Address - Street 2:INTERNAL MEDICINE RESIDENCY PROGRAM
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3842
Practice Address - Country:US
Practice Address - Phone:225-252-8349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA305966207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine