Provider Demographics
NPI:1386746220
Name:VASSA, NALINI TULSIDAS (MD)
Entity type:Individual
Prefix:DR
First Name:NALINI
Middle Name:TULSIDAS
Last Name:VASSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8514 W GAGE BLVD
Mailing Address - Street 2:STE G
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-8108
Mailing Address - Country:US
Mailing Address - Phone:509-222-1275
Mailing Address - Fax:509-491-3031
Practice Address - Street 1:510 N COLORADO ST
Practice Address - Street 2:SUITE A
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7770
Practice Address - Country:US
Practice Address - Phone:509-735-6689
Practice Address - Fax:509-735-6998
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044334174400000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0243128OtherLABOR & INDUSTRIES
WA8415580Medicaid
WAGAB11964Medicare ID - Type Unspecified
WA8877668Medicare PIN
WAF89056Medicare UPIN