Provider Demographics
NPI:1942302047
Name:RAJASENAN, VASUDEVAN (MD)
Entity Type:Individual
Prefix:
First Name:VASUDEVAN
Middle Name:
Last Name:RAJASENAN
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 1:300 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117-1924
Mailing Address - Country:US
Mailing Address - Phone:724-758-4850
Mailing Address - Fax:724-758-7621
Practice Address - Street 1:300 LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-1924
Practice Address - Country:US
Practice Address - Phone:724-758-4850
Practice Address - Fax:724-758-7621
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032865L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA030835E4WMedicare PIN