Provider Demographics
NPI:1992779789
Name:JANAKIRAMAN, VIJAYARAGHAVEN
Entity type:Individual
Prefix:
First Name:VIJAYARAGHAVEN
Middle Name:
Last Name:JANAKIRAMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 PLEASANT VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4641
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1528 PLEASANT VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4641
Practice Address - Country:US
Practice Address - Phone:814-944-4340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022103E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA206147OtherUPMC
PA232868515OtherGEISINGER
PA1038215OtherGATEWAY
PA060038525OtherRR MEDICARE
PA544232OtherBLUE SHIELD
PA609564700OtherUMWA
PA0008769420001Medicaid
PA232868515OtherUNITED HEALTHCARE
PA45384OtherHEALTH AMERICA/ASSURANCE
PA0008769420001Medicaid
PA098869JFNMedicare ID - Type Unspecified