=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689818478
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A M VEDHA, MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2009
-----------------------------------------------------
Last Update Date | 04/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1761 PARK AVE., SOUTHWEST
-----------------------------------------------------
City | NORTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24273-1626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-325-0461
-----------------------------------------------------
Fax | 276-325-0469
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1761 PARK AVE., SOUTHWEST
-----------------------------------------------------
City | NORTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24273-1626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-325-0461
-----------------------------------------------------
Fax | 276-325-0469
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ARUNACHALAM M. VEDHANAYAKAM
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 276-325-0461
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 0101023719
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------