MEDICARE: VILOK VIJAYANAGAR D.O.

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	208600000X	Surgery Physician	5101021800	MI

General Provider Information

NPI Number	:	1942681952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VILOK VIJAYANAGAR D.O.

Provider Business Mailing Address
First Line	:	PO BOX 402924
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-2924
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 SOUTH AVE STE 4A
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-3620
Country	:	US
Telephone Number	:	804-524-2294
Fax Number	:	804-524-0016

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

Provider Enumeration Date	:	06/16/2015
Last Update Date	:	07/13/2021

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