Individual
DR. VIJAYA BHASKAR GANDLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
601 N ELM ST, HIGH POINT, NC 27262-4331
(336) 878-6419
(336) 878-6420
Mailing address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 713-5215
(336) 716-0030
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2008-00921
NC
208M00000X
Hospitalist Physician
Primary
2008-00921
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149YG
BCBS OF NC
NC
05
—
5910711
—
NC
Enumeration date
06/25/2006
Last updated
08/31/2021
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