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General NPI Number Information
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NPI Number | 1821021122
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Entity Type | Individual
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Provider Name | VIJAY GOPAL HEGDE M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 08/10/2023
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Provider Practice Location Address
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Address Line | 430 MORTON PLANT ST STE 402
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City | CLEARWATER
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State | FL
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Zip | 33756-3395
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Country | US
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Telephone | 727-461-8635
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Fax | 727-333-6038
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Provider Business Mailing Address
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Address Line | 2995 DREW ST FL 2
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City | CLEARWATER
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State | FL
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Zip | 33759-3012
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Country | US
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Telephone | 727-315-7469
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 0101236816
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME160567
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License Number State | FL
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