Provider Demographics
NPI:1710959986
Name:SEN, DEVASHISH (MD)
Entity Type:Individual
Prefix:
First Name:DEVASHISH
Middle Name:
Last Name:SEN
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 1:402 CHATHAM SQUARE OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-2544
Mailing Address - Country:US
Mailing Address - Phone:540-659-5414
Mailing Address - Fax:540-659-5415
Practice Address - Street 1:402 CHATHAM SQUARE OFFICE PARK
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-2544
Practice Address - Country:US
Practice Address - Phone:540-659-5414
Practice Address - Fax:540-659-5415
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012431802081P2900X
NY239890208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101243180OtherVIRGINIA STATE LICENSE
1710959986Medicare PIN