Basic Information
| Provider Information | |||||||||
| NPI: | 1396965026 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | P.VASUDEVANMD,PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 603 BIG LAKE RD | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723642655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707393019 | ||||||||
| FaxNumber: | 8707393816 | ||||||||
| Practice Location | |||||||||
| Address1: | 1393 HIGHWAY 242 SOUTH | ||||||||
| Address2: | |||||||||
| City: | WEST HELENA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703386749 | ||||||||
| FaxNumber: | 8705726558 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | VASUDEVAN | ||||||||
| AuthorizedOfficialFirstName: | PARTHASARATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | UROLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 8707393019 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | R-2617 | AR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 1447367354 | 01 | AR | INDIVIDUAL NPI NO. | OTHER |