Healthcare Provider Details

I. General information

NPI: 1104090125
Provider Name (Legal Business Name): VIJAY HARI CHANDIRAMANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E AJO WAY
TUCSON AZ
85713-6204
US

IV. Provider business mailing address

7261 E CROOKED CREEK CT
TUCSON AZ
85750-6108
US

V. Phone/Fax

Practice location:
  • Phone: 520-874-2850
  • Fax: 520-448-3903
Mailing address:
  • Phone: 607-215-2412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number40820
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: