Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 11852 | ND |
NPI | 1285834614 |
---|---|
Provider Name | Dr. Vijay Neelamegam Premnath |
First Address | Tioga, ND 58852 |
Second Address | Tioga, ND 58852 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2007 |
Last Update Date | 21/08/2013 |