Provider Demographics
NPI:1821288804
Name:C.P. VASUDEVAN,M.D.,P.C.
Entity Type:Organization
Organization Name:C.P. VASUDEVAN,M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CUDDALORE
Authorized Official - Middle Name:P
Authorized Official - Last Name:VASUDEVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-322-5864
Mailing Address - Street 1:2117 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605-2002
Mailing Address - Country:US
Mailing Address - Phone:276-322-5864
Mailing Address - Fax:
Practice Address - Street 1:2117 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-2002
Practice Address - Country:US
Practice Address - Phone:276-322-5864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1821288804Medicaid
WV290006991OtherRAILROAD MEDICARE
WV3810010120Medicaid
4353209OtherAETNA
VAP00450347OtherRAIL ROAD MEDICARE
001995560OtherMOUNTAIN STATE BC
612758800OtherDEPARTMENT OF LABOR
VA308652OtherSOUTHEAST SERVICES
612758800OtherDEPARTMENT OF LABOR
VAC10316Medicare PIN