Healthcare Provider Details

I. General information

NPI: 1831483965
Provider Name (Legal Business Name): VIJAYETA IYER RANGARAJAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VIJAYETA VAIDYANATHAN IYER M.D.

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

1959 NE PACIFIC ST
SEATTLE WA
98195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 734-945-9081
  • Fax:
Mailing address:
  • Phone: 734-945-9081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA116651
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number60287291
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD60287291
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: