Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 92500 | OH |
N | 111NI0900X | Internist | 92500 | OH |
Y | 207RI0200X | Infectious Disease | 44007 | KY |
NPI | 1063658623 |
---|---|
Provider Name | Vidya Rajaram Devarajan |
First Address | Edgewood, KY 41017-5401 |
Second Address | Edgewood, KY 41017-5401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2008 |
Last Update Date | 10/01/2014 |