Healthcare Provider Details

I. General information

NPI: 1669462040
Provider Name (Legal Business Name): VIJAY RAJ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 04/12/2025
Certification Date: 04/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19873 MAGNOLIA SPRINGS WAY
LAND O LAKES FL
34638-8803
US

IV. Provider business mailing address

19873 MAGNOLIA SPRINGS WAY
LAND O LAKES FL
34638-8803
US

V. Phone/Fax

Practice location:
  • Phone: 571-344-8084
  • Fax:
Mailing address:
  • Phone: 571-344-8084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number0101035132
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME128772
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME 128772
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: