Provider Demographics
NPI:1427276823
Name:VIRK, EJAZ (MD)
Entity type:Individual
Prefix:DR
First Name:EJAZ
Middle Name:
Last Name:VIRK
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 381554
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-1554
Mailing Address - Country:US
Mailing Address - Phone:901-524-1200
Mailing Address - Fax:
Practice Address - Street 1:3173 KIRBY WHITTEN RD
Practice Address - Street 2:STE 104
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134
Practice Address - Country:US
Practice Address - Phone:901-524-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN278462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1508445Medicaid
MS00123049Medicaid
AR135344001Medicaid
TN103I265082OtherTN MEDICARE