Provider Demographics
NPI:1720392681
Name:VEGASANA, MAYURI RAJU (MD)
Entity Type:Individual
Prefix:DR
First Name:MAYURI
Middle Name:RAJU
Last Name:VEGASANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MAYURI
Other - Middle Name:RAJU
Other - Last Name:KOSURI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:330-253-4931
Mailing Address - Fax:330-253-8619
Practice Address - Street 1:1463 CANTON RD STE A
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-4022
Practice Address - Country:US
Practice Address - Phone:330-253-4931
Practice Address - Fax:330-253-8619
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.125763208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics