Individual
DR. VIJAY RAVEENDRAN POTTATHIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
300 PASTEUR DR, STANFORD, CA 94305-2200
(650) 723-4000
Mailing address
300 PASTEUR DR, STANFORD, CA 94305-2200
(650) 723-4000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
39494
IA
207RG0100X
Gastroenterology Physician
Primary
A147576
CA
207RG0100X
Gastroenterology Physician
MD-39493
IA
208M00000X
Hospitalist Physician
39493
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053546945
—
IA
Enumeration date
05/20/2009
Last updated
07/21/2022
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