Basic Information
| Provider Information | |||||||||
| NPI: | 1285616888 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAJLA | ||||||||
| FirstName: | VIJAY | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 PLANTATION ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085952000 | ||||||||
| FaxNumber: | 5088537149 | ||||||||
| Practice Location | |||||||||
| Address1: | 630 PLANTATION ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085952000 | ||||||||
| FaxNumber: | 5088537149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 02/16/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 209272 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 5603502 | 01 | AETNA US HEALTHCARE | OTHER | AA5966 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | J23373 | 01 | BLUE SHIELD INDEMNITY | OTHER | 042472266 | 01 | THREE RIVERS | OTHER | J23373 | 01 | BLUE CARE ELECT | OTHER | 042472266 | 01 | HEALTHCARE VALUE MGMT | OTHER | 1601039 | 01 | FIRST HEALTH | OTHER | 380001633 | 01 | RAILROAD MEDICARE | OTHER | A32547 | 01 | MEDICARE B | OTHER | 49277 | 01 | FALLON COMMUNITY HEALTH | OTHER | 0140481 | 01 | HEALTHY START | OTHER | 0402313 | 01 | EVERCARE | OTHER | 1574863 | 01 | CIGNA HEALTH PLAN | OTHER | 784034 | 01 | MVP HEALTH CARE | OTHER | 0140481 | 01 | MEDICAID WELFARE | OTHER | 0140481 | 05 | MA | MEDICAID | J23372 | 01 | BLUE SHIELD HMO BLUE | OTHER |