MEDICARE: MR. VIJAY RAJ 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	207QA0505X	Adult Medicine Physician	0101035132	VA
2	208D00000X	General Practice Physician	ME128772	FL
3	208D00000X	General Practice Physician	ME 128772	FL

General Provider Information

NPI Number	:	1669462040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VIJAY RAJ MD

Provider Business Mailing Address
First Line	:	19873 MAGNOLIA SPRINGS WAY
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34638-8803
Country	:	US
Telephone Number	:	571-344-8084
Fax Number	:

Provider Business Practice Location Address
First Line	:	19873 MAGNOLIA SPRINGS WAY
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34638-8803
Country	:	US
Telephone Number	:	571-344-8084
Fax Number	:

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	04/12/2025

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