Healthcare Provider Details

I. General information

NPI: 1760629240
Provider Name (Legal Business Name): VINAYA KUMAR JAGADEESHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 E 29TH ST STE A COGENT HEALTHCARE OF TEXAS, P.A.
BRYAN TX
77802-2501
US

IV. Provider business mailing address

5410 MARYLAND WAY STE 300 COGENT HEALTHCARE, INC.
BRENTWOOD TN
37027-5339
US

V. Phone/Fax

Practice location:
  • Phone: 979-776-5967
  • Fax: 979-774-4849
Mailing address:
  • Phone: 615-377-5652
  • Fax: 615-377-1687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN3754
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: