Provider Demographics
NPI:1366556821
Name:KONDA, VIJAY K (MD)
Entity type:Individual
Prefix:
First Name:VIJAY
Middle Name:K
Last Name:KONDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1879 VETERANS PARK DR STE 1202
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0500
Mailing Address - Country:US
Mailing Address - Phone:239-260-7610
Mailing Address - Fax:
Practice Address - Street 1:1879 VETERANS PARK DR STE 1202
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0500
Practice Address - Country:US
Practice Address - Phone:239-260-7610
Practice Address - Fax:239-260-7615
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96103207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2769077-00Medicaid
GA976889098AMedicaid
FLAA597YMedicare PIN
FLP00436483Medicare PIN