Basic Information
| Provider Information | |||||||||
| NPI: | 1851554067 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TALREJA | ||||||||
| FirstName: | VIJAY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60447 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043163789 | ||||||||
| FaxNumber: | 7043166785 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 MATTHEWS TOWNSHIP PKWY | ||||||||
| Address2: | |||||||||
| City: | MATTHEWS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281054656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043849740 | ||||||||
| FaxNumber: | 7043849565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2008 | ||||||||
| LastUpdateDate: | 10/26/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2011-01131 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | 2011-01131 | NC | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 1851554067 | 05 | NC | MEDICAID | 374829 | 05 | SC | MEDICAID |