Provider Demographics
NPI:1467408963
Name:VASANI, RAMESH P (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMESH
Middle Name:P
Last Name:VASANI
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:PO BOX 893
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-0014
Mailing Address - Country:US
Mailing Address - Phone:972-563-2678
Mailing Address - Fax:972-551-6977
Practice Address - Street 1:1553 HWY 34 SOUTH STE 200
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160
Practice Address - Country:US
Practice Address - Phone:972-563-2678
Practice Address - Fax:972-551-6977
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2019-12-04
Deactivation Date:2019-10-03
Deactivation Code:
Reactivation Date:2019-12-04
Provider Licenses
StateLicense IDTaxonomies
TXF6145208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127116501Medicaid
D69219Medicare UPIN