Provider Demographics
NPI:1114982881
Name:GOLI, VASUDEVA RAO (MD)
Entity type:Individual
Prefix:DR
First Name:VASUDEVA
Middle Name:RAO
Last Name:GOLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:801 PRINCETON AVE SW
Mailing Address - Street 2:SUITE 707
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-1310
Mailing Address - Country:US
Mailing Address - Phone:205-780-4330
Mailing Address - Fax:205-780-7775
Practice Address - Street 1:817 PRINCETON AVE SW
Practice Address - Street 2:PROFESSIONAL BLDG 2 SUITE 202
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1333
Practice Address - Country:US
Practice Address - Phone:205-786-8815
Practice Address - Fax:205-786-8835
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL16528207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5152620Medicaid
AL51512620GOLMedicare ID - Type UnspecifiedMEDICARE/BCBS PROVIDER NO
ALC16220Medicare UPIN