Provider Demographics
NPI:1194773994
Name:CHIRUMAMILLA, VIJAYA LAKSHMI (MD)
Entity type:Individual
Prefix:DR
First Name:VIJAYA
Middle Name:LAKSHMI
Last Name:CHIRUMAMILLA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3400 S CRATER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-9211
Mailing Address - Country:US
Mailing Address - Phone:804-733-6960
Mailing Address - Fax:804-733-3880
Practice Address - Street 1:3400 S CRATER RD
Practice Address - Street 2:SUITE B
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9211
Practice Address - Country:US
Practice Address - Phone:804-733-6960
Practice Address - Fax:804-733-3880
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2020-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101044813207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006034403Medicaid
VA1194773994Medicare PIN
VAB12011Medicare UPIN