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NPI Code Detail

MEDICARE: AJAY VEERAGANDHAM MD

MEDICARE: AJAY VEERAGANDHAM 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
12084P0800XPsychiatry Physician200301070NC
22084P0804XChild & Adolescent Psychiatry Physician200301070NC

Other Identifiers

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

General Provider Information

NPI Number : 1558467571
Entity Type Code : Individual
Provider Name (Legal Business Name) : AJAY VEERAGANDHAM MD
Provider Business Mailing Address
First Line : 200 TARPON TRL
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28546-5287
Country : US
Telephone Number : 910-938-1114
Fax Number : 910-938-1118
Provider Business Practice Location Address
First Line : 200 TARPON TRL
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28546-5287
Country : US
Telephone Number : 910-938-1114
Fax Number : 910-938-1118
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2006
Last Update Date : 11/12/2012

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Directions to “ AJAY VEERAGANDHAM MD” Practice Location

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