Provider Demographics
NPI:1972571677
Name:BUDDHADEV, ASHOK G (MD)
Entity Type:Individual
Prefix:
First Name:ASHOK
Middle Name:G
Last Name:BUDDHADEV
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 1:800 MEDICAL CT E
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4612
Mailing Address - Country:US
Mailing Address - Phone:352-726-7667
Mailing Address - Fax:352-726-8193
Practice Address - Street 1:800 MEDICAL CT E
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4612
Practice Address - Country:US
Practice Address - Phone:352-726-7667
Practice Address - Fax:352-726-8193
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067232207V00000X
FL137982207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0985475Medicaid
OH0985475Medicaid
OHBU0768151Medicare PIN