Healthcare Provider Details

I. General information

NPI: 1427376524
Provider Name (Legal Business Name): VINAY VAJJHALA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

0 UNIVERSITY DRIVE C
PITTSBURGH PA
15240-1000
US

IV. Provider business mailing address

1736 TAPER DR
PITTSBURGH PA
15241-2624
US

V. Phone/Fax

Practice location:
  • Phone: 412-360-6326
  • Fax: 412-360-2996
Mailing address:
  • Phone: 412-606-6867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD450782
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: