Provider Demographics
NPI:1558357558
Name:VASUDEVAN, VISWANATH PARAMESWAR (MD)
Entity Type:Individual
Prefix:DR
First Name:VISWANATH
Middle Name:PARAMESWAR
Last Name:VASUDEVAN
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 1:13 TURF LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2713
Mailing Address - Country:US
Mailing Address - Phone:516-484-2160
Mailing Address - Fax:516-484-5681
Practice Address - Street 1:13 TURF LN
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2713
Practice Address - Country:US
Practice Address - Phone:516-484-2160
Practice Address - Fax:516-484-5681
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-25
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142946207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01299256Medicaid
NY12G593Medicare ID - Type Unspecified
NY02108BMedicare ID - Type Unspecified
NYF20778Medicare UPIN