MEDICARE: MS. VIJAY SHRI KANNAN 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	207P00000X	Emergency Medicine Physician	D0063183	MD
2	207R00000X	Internal Medicine Physician	D63183	MD

General Provider Information

NPI Number	:	1942295621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VIJAY SHRI KANNAN M.D.

Provider Business Mailing Address
First Line	:	10301 GEORGIA AVE
Second Line	:	203
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-5020
Country	:	US
Telephone Number	:	301-681-7010
Fax Number	:	301-593-8366

Provider Business Practice Location Address
First Line	:	10301 GEORGIA AVE
Second Line	:	203
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-5020
Country	:	US
Telephone Number	:	301-681-7010
Fax Number	:	301-593-8366

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	07/09/2012

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