Healthcare Provider Details

I. General information

NPI: 1821021122
Provider Name (Legal Business Name): VIJAY GOPAL HEGDE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 MORTON PLANT ST STE 402
CLEARWATER FL
33756-3395
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 727-461-8635
  • Fax: 727-333-6038
Mailing address:
  • Phone: 727-315-7469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101236816
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME160567
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: