Provider Demographics
NPI:1821081688
Name:VASUDEVAN, RAM (M D)
Entity Type:Individual
Prefix:
First Name:RAM
Middle Name:
Last Name:VASUDEVAN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:RAMABHADRAN
Other - Middle Name:
Other - Last Name:VASUDEVAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:M D
Mailing Address - Street 1:1040 SW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0926
Mailing Address - Country:US
Mailing Address - Phone:352-732-3005
Mailing Address - Fax:
Practice Address - Street 1:1040 SW 2ND AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4226
Practice Address - Country:US
Practice Address - Phone:352-732-3005
Practice Address - Fax:352-732-9828
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51747207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061803900Medicaid
FLE22907Medicare UPIN
08834YMedicare PIN