Provider Demographics
NPI:1306994918
Name:GHATE, VIJAY R (MD)
Entity type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:R
Last Name:GHATE
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 1:612 WINTER BREEZE CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-5096
Mailing Address - Country:US
Mailing Address - Phone:919-233-6731
Mailing Address - Fax:
Practice Address - Street 1:5509 CREEDMOOR RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-6312
Practice Address - Country:US
Practice Address - Phone:919-573-6520
Practice Address - Fax:919-573-6555
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC171322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC35176OtherBCCS
NC8935176Medicaid
NC35176OtherBCCS
NC083396Medicare UPIN