Provider Demographics
NPI:1376541649
Name:VASAN, SRINI (MD)
Entity Type:Individual
Prefix:
First Name:SRINI
Middle Name:
Last Name:VASAN
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 1:416 COLEGATE DR BLDG 3
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-9549
Mailing Address - Country:US
Mailing Address - Phone:740-568-4814
Mailing Address - Fax:740-374-3165
Practice Address - Street 1:807 FARSON ST STE 116
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1068
Practice Address - Country:US
Practice Address - Phone:740-376-1960
Practice Address - Fax:740-376-5037
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV139342085R0001X
OH35.0523482085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0123692000Medicaid
OH0576149Medicaid
OH000000545268OtherANTHEM
OH000000696934OtherANTHEM
OHP00468347OtherRRMCR
OH0576149Medicaid
WV0550336Medicare PIN
OH7418681Medicare PIN
OH000000545268OtherANTHEM