Basic Information
| Provider Information | |||||||||
| NPI: | 1942295621 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KANNAN | ||||||||
| FirstName: | VIJAY | ||||||||
| MiddleName: | SHRI | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10301 GEORGIA AVE | ||||||||
| Address2: | 203 | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209025020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016817010 | ||||||||
| FaxNumber: | 3015938366 | ||||||||
| Practice Location | |||||||||
| Address1: | 10301 GEORGIA AVE | ||||||||
| Address2: | 203 | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209025020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016817010 | ||||||||
| FaxNumber: | 3015938366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2005 | ||||||||
| LastUpdateDate: | 07/09/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | D0063183 | MD | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | D63183 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.