Provider Demographics
NPI:1922045665
Name:VEDULA, DEVI (MD)
Entity Type:Individual
Prefix:
First Name:DEVI
Middle Name:
Last Name:VEDULA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 CENTRE ST
Mailing Address - Street 2:BROCKTON HOSPITAL
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3308
Mailing Address - Country:US
Mailing Address - Phone:781-878-1700
Mailing Address - Fax:781-871-4375
Practice Address - Street 1:680 CENTRE ST
Practice Address - Street 2:BROCKTON HOSPITAL
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3308
Practice Address - Country:US
Practice Address - Phone:781-878-1700
Practice Address - Fax:781-871-4375
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210890207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2137887Medicaid
MA2137887Medicaid