Provider Demographics
NPI:1689601718
Name:DHULIPALA, VASUDEVA V (MD)
Entity Type:Individual
Prefix:
First Name:VASUDEVA
Middle Name:V
Last Name:DHULIPALA
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 1:104 N 3RD ST
Mailing Address - Street 2:6701 TENNYSON OAKS LN
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301
Mailing Address - Country:US
Mailing Address - Phone:318-449-8334
Mailing Address - Fax:318-449-8322
Practice Address - Street 1:104 N 3RD ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301
Practice Address - Country:US
Practice Address - Phone:318-449-8334
Practice Address - Fax:318-449-8322
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08641R208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1911143Medicaid
5N446Medicare ID - Type Unspecified
LA1911143Medicaid