Provider Demographics
NPI:1326063058
Name:KAMATH, VASUDEVA M (MD)
Entity Type:Individual
Prefix:
First Name:VASUDEVA
Middle Name:M
Last Name:KAMATH
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3104
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77305-3104
Mailing Address - Country:US
Mailing Address - Phone:936-539-7757
Mailing Address - Fax:936-788-8046
Practice Address - Street 1:504 MEDICAL CENTER BLVD
Practice Address - Street 2:NICU CRMC
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2808
Practice Address - Country:US
Practice Address - Phone:936-539-7757
Practice Address - Fax:936-788-8046
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2017-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM0122174400000X
NY207490174400000X
NY207490-12080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181801501Medicaid
TX8W1652OtherBLUECROSS
NYF85385Medicare UPIN