Provider Demographics
NPI:1407827629
Name:MADHAVAN, VASANTHA C (MD)
Entity Type:Individual
Prefix:DR
First Name:VASANTHA
Middle Name:C
Last Name:MADHAVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21 YOST BLVD
Mailing Address - Street 2:FOREST HILLS PLAZA-SUITE 216
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-5283
Mailing Address - Country:US
Mailing Address - Phone:412-823-3113
Mailing Address - Fax:412-824-8634
Practice Address - Street 1:21 YOST BLVD
Practice Address - Street 2:FOREST HILLS PLAZA-SUITE 216
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-5283
Practice Address - Country:US
Practice Address - Phone:412-823-3113
Practice Address - Fax:412-824-8634
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD027285E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008930950014Medicaid
PA102417OtherUPMC HEALTH PLAN
PA102417OtherUPMC FOR LIFE
PA1538649OtherGATEWAY
PA244070OtherCOVENTRY HEALTHCARE
PA155597OtherMEDPLUS
PA7974591OtherAETNA
PA201362491OtherTRICARE
PA102417OtherUPMC FOR YOU
PA201362491OtherUNITED HEALTHCARE
PA060007476OtherRAILROAD MEDICARE
PA1629728OtherHIGHMARK BCBS
PA1834861002OtherCIGNA
PA102417OtherUPMC FOR LIFE
PA201362491OtherUNITED HEALTHCARE