Provider Demographics
NPI:1902197908
Name:INAMDAR, VATSAL (MD)
Entity Type:Individual
Prefix:
First Name:VATSAL
Middle Name:
Last Name:INAMDAR
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 1:161 TARA OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8307
Mailing Address - Country:US
Mailing Address - Phone:201-892-5585
Mailing Address - Fax:
Practice Address - Street 1:1149 MAIN ST
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-7721
Practice Address - Country:US
Practice Address - Phone:352-674-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114151207RC0001X, 207RC0000X
NY243884207RC0000X
AZ44371207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ146076Medicare PIN