Provider Demographics
NPI:1508158544
Name:VASUKI, NAGAVIVEK PAAVAN (MD)
Entity Type:Individual
Prefix:
First Name:NAGAVIVEK
Middle Name:PAAVAN
Last Name:VASUKI
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 1:400 N CASHUA DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-2098
Mailing Address - Country:US
Mailing Address - Phone:843-664-9393
Mailing Address - Fax:843-664-9661
Practice Address - Street 1:400 N CASHUA DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-2098
Practice Address - Country:US
Practice Address - Phone:843-664-9393
Practice Address - Fax:843-664-9661
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC173270207R00000X
VA390200000X
SCTL38008207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program