MEDICARE: DR. SRINIVASAN VIJAYAKUMAR M.D.

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	2085R0001X	Radiation Oncology Physician	C50983	CA

General Provider Information

NPI Number	:	1184607210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SRINIVASAN VIJAYAKUMAR M.D.

Provider Business Mailing Address
First Line	:	2500 N STATE ST
Second Line	:	RADIATION ONCOLOGY
City	:	JACKSON
State	:	MS
Zip	:	39216-4500
Country	:	US
Telephone Number	:	601-815-6886
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 W WOODROW WILSON AVE
Second Line	:	SUITE 16
City	:	JACKSON
State	:	MS
Zip	:	39213-7681
Country	:	US
Telephone Number	:	601-815-6886
Fax Number	:

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	07/16/2012

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