Provider Demographics
NPI:1316959968
Name:MOULANA, VASEEM (MD)
Entity type:Individual
Prefix:DR
First Name:VASEEM
Middle Name:
Last Name:MOULANA
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 1:1240 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2767
Mailing Address - Country:US
Mailing Address - Phone:270-769-9881
Mailing Address - Fax:270-769-9589
Practice Address - Street 1:1240 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2767
Practice Address - Country:US
Practice Address - Phone:270-769-9881
Practice Address - Fax:270-769-9589
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31779207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64317795Medicaid
KY64317795Medicaid
KYP400016784Medicare PIN