MEDICARE: VIJAYA NAMA MD PA

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	261QP2300X	Primary Care Clinic/Center	L7821	TX

General Provider Information

NPI Number	:	1073520177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIJAYA NAMA MD PA

Provider Business Mailing Address
First Line	:	407 W INTERSTATE 30
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75043-5912
Country	:	US
Telephone Number	:	972-303-3000
Fax Number	:	972-303-3003

Provider Business Practice Location Address
First Line	:	407 W INTERSTATE 30
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75043-5912
Country	:	US
Telephone Number	:	972-303-3000
Fax Number	:	972-303-3003

Authorized Official
Title or Position	:	OWNER
Name	:	VIJAYA NAMA
Credential	:	M.D.
Telephone Number	:	972-303-3000

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	08/22/2020

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