Provider Demographics
NPI:1972734986
Name:NAGABHAIRU, VINOD KUMAR (MD)
Entity type:Individual
Prefix:
First Name:VINOD
Middle Name:KUMAR
Last Name:NAGABHAIRU
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 1549
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-9049
Mailing Address - Country:US
Mailing Address - Phone:717-462-1843
Mailing Address - Fax:717-661-1381
Practice Address - Street 1:503 SHAW ST
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-4151
Practice Address - Country:US
Practice Address - Phone:717-462-1843
Practice Address - Fax:717-661-1381
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD448533208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102888883Medicaid
PA102888883Medicaid