DIVYA GOUTAM VIJENDRA M.D. NPI 1164502373

NPI Information

NPI: 1164502373
Provider Name: DIVYA GOUTAM VIJENDRA, M.D.
Classification: Internal Medicine - 207RX0202X
Entity Type: Individual

Specialization: Medical Oncology

PECOS Registration: Yes

Address:
433 W HIGH ST
BRYAN, OH
ZIP 43506
Phone: (419) 636-1131
Get Directions

Divya Goutam Vijendra, M.D. is a medical oncology internal medicine in Bryan, OH with 27 years of experience. The provider is an internist who specializes in the diagnosis and treatment of all types of cancer and other benign and malignant tumors. This specialist decides on and administers therapy for these malignancies as well as consults with surgeons and radiotherapists on other treatments for cancer. Divya Goutam Vijendra, M.D. NPI is 1164502373. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

433 W HIGH ST
BRYAN, OH
ZIP 43506-690
Phone: (419) 636-1131
Fax: (419) 636-3100

The NPI 1164502373 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/16/2006 and was last updated on 8/20/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207R00000X	Internal Medicine		35-084674	OHIO	No
2	207RG0300X	Internal Medicine	Geriatric Medicine	35084674	OHIO	No
3	207RX0202X	Internal Medicine	Medical Oncology	35084674	OHIO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	2491683	MEDICAID	OHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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