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
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3419 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5420
Mailing Address - Country:US
Mailing Address - Phone:549-892-8009
Mailing Address - Fax:
Practice Address - Street 1:3419 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5420
Practice Address - Country:US
Practice Address - Phone:549-892-8009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2022-07-12
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
MO200095944Medicaid
101030129OtherMEDICARE