MEDICARE: DR. PRERNA VIJAYVARGIYA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME68903	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043210826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRERNA VIJAYVARGIYA MD

Provider Business Mailing Address
First Line	:	3300 S FISKE BLVD
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4306
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 N SYKES CREEK PKWY STE 301
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-3490
Country	:	US
Telephone Number	:	321-361-5536
Fax Number	:	321-361-5543

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	03/13/2020

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