=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366629628
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | V.P. NAGARAJAN, M.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2008
-----------------------------------------------------
Last Update Date | 05/24/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12202 CORTEZ BLVD
-----------------------------------------------------
City | BROOKSVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34613-2630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-592-7779
-----------------------------------------------------
Fax | 352-592-7677
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12202 CORTEZ BLVD
-----------------------------------------------------
City | BROOKSVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34613-2631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-592-7779
-----------------------------------------------------
Fax | 352-592-7677
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. DIANE R SLAVINSKI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 352-592-7779
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | ME30767
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------