Provider Demographics
NPI:1164798617
Name:VIJAYAKANTHAN, MARINA GHAYATHRIE (MD)
Entity type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:GHAYATHRIE
Last Name:VIJAYAKANTHAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:800 TURNPIKE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-6156
Mailing Address - Country:US
Mailing Address - Phone:978-794-5511
Mailing Address - Fax:978-685-1048
Practice Address - Street 1:800 TURNPIKE ST STE 300
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-6156
Practice Address - Country:US
Practice Address - Phone:978-794-5511
Practice Address - Fax:978-685-1048
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2024-04-29
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Provider Licenses
StateLicense IDTaxonomies
NH166532084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry