Healthcare Provider Details

I. General information

NPI: 1851520936
Provider Name (Legal Business Name): JOSJIN VAZHAPPILLY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 TIDEWATER COLONY DR SUITE 1 A
ANNAPOLIS MD
21401-2101
US

IV. Provider business mailing address

2007 TIDEWATER COLONY DR SUITE 1 A
ANNAPOLIS MD
21401-2101
US

V. Phone/Fax

Practice location:
  • Phone: 443-949-0814
  • Fax: 443-949-0825
Mailing address:
  • Phone: 443-949-0814
  • Fax: 443-949-0825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberD0071199
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0071199
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: