=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053839977
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIJAY KUMAR PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2017
-----------------------------------------------------
Last Update Date | 09/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 610 PARK AVENUE NW
-----------------------------------------------------
City | NORTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24273
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-321-7866
-----------------------------------------------------
Fax | 276-321-7843
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 610 PARK AVENUE NW
-----------------------------------------------------
City | NORTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24273
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-325-0121
-----------------------------------------------------
Fax | 276-321-7843
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | VIJAY KUMAR
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 423-943-9415
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------