Provider Demographics
NPI:1194767806
Name:DULAM, VIKRAMADITYA (MD)
Entity type:Individual
Prefix:PROF
First Name:VIKRAMADITYA
Middle Name:
Last Name:DULAM
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 1:140 JEFFERSON DAVIS BLVD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-5104
Mailing Address - Country:US
Mailing Address - Phone:601-304-9718
Mailing Address - Fax:601-304-9637
Practice Address - Street 1:140 JEFFERSON DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-5104
Practice Address - Country:US
Practice Address - Phone:601-304-9718
Practice Address - Fax:601-304-9637
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18344207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02602371Medicaid
1197785OtherLOUISIANA MEDICAID
MS02602371Medicaid