Provider Demographics
NPI:1043203888
Name:VASUDEVAN, ANJU (M D)
Entity Type:Individual
Prefix:
First Name:ANJU
Middle Name:
Last Name:VASUDEVAN
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:ANJU
Other - Middle Name:
Other - Last Name:BHASIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3130 SW 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-4445
Mailing Address - Country:US
Mailing Address - Phone:352-732-4032
Mailing Address - Fax:352-732-4191
Practice Address - Street 1:3130 SW 32ND AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4445
Practice Address - Country:US
Practice Address - Phone:352-732-4032
Practice Address - Fax:352-732-4191
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME52275207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061804700Medicaid
08835YMedicare PIN
FLE30587Medicare UPIN
FL061804700Medicaid