Individual
DR. NAGARAJA VISHAKANTAIAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4692 BROWNSBORO RD, WINSTON SALEM, NC 27106-3410
(336) 251-1114
(336) 251-1117
Mailing address
4692 BROWNSBORO RD, WINSTON SALEM, NC 27106-3410
(336) 251-1114
(336) 251-1117
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101840596
VA
207Q00000X
Family Medicine Physician
Primary
2018-02625
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010052360
—
VA
Enumeration date
07/12/2005
Last updated
11/28/2018
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