Provider Demographics
NPI:1235271784
Name:GABBUR, VASUDEV (MD)
Entity Type:Individual
Prefix:DR
First Name:VASUDEV
Middle Name:
Last Name:GABBUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 13TH ST # A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5175
Mailing Address - Country:US
Mailing Address - Phone:718-499-5351
Mailing Address - Fax:718-499-7346
Practice Address - Street 1:398 13TH ST # A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-5175
Practice Address - Country:US
Practice Address - Phone:718-499-5351
Practice Address - Fax:718-499-7346
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114257208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00209114Medicaid