Provider Demographics
NPI:1750494464
Name:VASEEM MOULANA MD PSC
Entity Type:Organization
Organization Name:VASEEM MOULANA MD PSC
Other - Org Name:WOODLAND MEDICAL SPECIALISTS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VASEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOULANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-769-9881
Mailing Address - Street 1:1240 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2767
Mailing Address - Country:US
Mailing Address - Phone:270-769-9881
Mailing Address - Fax:270-769-9589
Practice Address - Street 1:1240 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2767
Practice Address - Country:US
Practice Address - Phone:270-769-9881
Practice Address - Fax:270-769-9589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31779207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64317795Medicaid
KY64317795Medicaid
KYP100016783Medicare PIN