Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 85219 | GA |
N | 207RI0011X | Interventional Cardiology | 85219 | GA |
NPI | 1649563255 |
---|---|
Provider Name | Vikram Gautam Pankaj Raje |
First Address | Atlanta, GA 30374-2616 |
Second Address | Gainesville, GA 30501-3715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2011 |
Last Update Date | 07/12/2020 |