Provider Demographics
NPI:1396965026
Name:P.VASUDEVANMD,PLLC
Entity type:Organization
Organization Name:P.VASUDEVANMD,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PARTHASARATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:VASUDEVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-739-3019
Mailing Address - Street 1:603 BIG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-2655
Mailing Address - Country:US
Mailing Address - Phone:870-739-3019
Mailing Address - Fax:870-739-3816
Practice Address - Street 1:1393 HIGHWAY 242 SOUTH
Practice Address - Street 2:
Practice Address - City:WEST HELENA
Practice Address - State:AR
Practice Address - Zip Code:72342
Practice Address - Country:US
Practice Address - Phone:870-338-6749
Practice Address - Fax:870-572-6558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-2617208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1447367354OtherINDIVIDUAL NPI NO.
AR5-5409Medicare ID - Type Unspecified
ARD 17145Medicare UPIN