Provider Demographics
NPI:1427051929
Name:SWARUP, VIJENDRA (MD)
Entity type:Individual
Prefix:DR
First Name:VIJENDRA
Middle Name:
Last Name:SWARUP
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:PO BOX 11191
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4002
Mailing Address - Country:US
Mailing Address - Phone:602-456-2342
Mailing Address - Fax:602-688-2342
Practice Address - Street 1:1848 E THOMAS RD STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-8112
Practice Address - Country:US
Practice Address - Phone:602-456-2342
Practice Address - Fax:602-688-2342
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30467207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ701674Medicaid
AZ701674Medicaid
AZZ137298Medicare PIN