Provider Demographics
NPI:1487608105
Name:MAMEDI, VIJAYALAKSHMI (MD)
Entity type:Individual
Prefix:DR
First Name:VIJAYALAKSHMI
Middle Name:
Last Name:MAMEDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VIJAYALAKSHMI
Other - Middle Name:
Other - Last Name:ANDOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2066 HWY 125
Mailing Address - Street 2:RURAL HEALTH GROUP,
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-9346
Mailing Address - Country:US
Mailing Address - Phone:252-536-5000
Mailing Address - Fax:
Practice Address - Street 1:2066 HWY 125
Practice Address - Street 2:RURAL HEALTH GROUP,
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870
Practice Address - Country:US
Practice Address - Phone:252-536-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01715207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine