Provider Demographics
NPI:1588198089
Name:DEOSARAN, ANSUYA PRITHAVI (MD)
Entity type:Individual
Prefix:DR
First Name:ANSUYA
Middle Name:PRITHAVI
Last Name:DEOSARAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3280 OLD BOYNTON RD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-6506
Mailing Address - Country:US
Mailing Address - Phone:561-733-3010
Mailing Address - Fax:561-733-0039
Practice Address - Street 1:3280 OLD BOYNTON RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-6506
Practice Address - Country:US
Practice Address - Phone:561-733-3010
Practice Address - Fax:561-733-0039
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021014728207W00000X
FLME155392207WX0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
101030129OtherMEDICARE
MO200095944Medicaid