Provider Demographics
NPI:1164530051
Name:PAI, VOSUDESH K
Entity Type:Individual
Prefix:DR
First Name:VOSUDESH
Middle Name:K
Last Name:PAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 PROFESSIONAL DR
Mailing Address - Street 2:SUITE # 350
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3367
Mailing Address - Country:US
Mailing Address - Phone:770-995-0630
Mailing Address - Fax:678-942-5984
Practice Address - Street 1:631 PROFESSIONAL DR
Practice Address - Street 2:SUITE # 350
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3367
Practice Address - Country:US
Practice Address - Phone:770-995-0630
Practice Address - Fax:678-942-5980
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA065983207RP1001X, 207RP1001X
GA65983207RS0012X, 207RC0200X
NJ25MA08292100207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016209610001Medicaid
NJP00953008OtherR R MCR
NJ0164615Medicaid
NJ124994AT2Medicare PIN
096544Medicare ID - Type Unspecified
PA1016209610001Medicaid