Provider Demographics
NPI:1215041975
Name:VASUDEVAN, SREEKALA (MD)
Entity Type:Individual
Prefix:
First Name:SREEKALA
Middle Name:
Last Name:VASUDEVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 COPELAND DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1225
Mailing Address - Country:US
Mailing Address - Phone:508-339-4144
Mailing Address - Fax:508-261-9940
Practice Address - Street 1:200 COPELAND DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1225
Practice Address - Country:US
Practice Address - Phone:508-339-4144
Practice Address - Fax:508-261-9940
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD 9085207R00000X
MA257722207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000023389OtherRIBC
789085OtherTUFTS
847334OtherCOVENTRY
061480182OtherAETNA
AA7552OtherHPHC
0000176100909OtherUHC
5881310OtherCIGNA
402618OtherBLUE CHIP RI
5881310OtherCIGNA
789085OtherTUFTS