Provider Demographics
NPI:1992882096
Name:VASUDEVAN RAJASENAN A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:VASUDEVAN RAJASENAN A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:VASUDEVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJASENAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-758-4850
Mailing Address - Street 1:300 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117-1924
Mailing Address - Country:US
Mailing Address - Phone:724-758-4850
Mailing Address - Fax:724-758-7621
Practice Address - Street 1:300 LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-1924
Practice Address - Country:US
Practice Address - Phone:724-758-4850
Practice Address - Fax:724-758-7621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032865L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA030835OtherHIGHMARK BCBS
B33688Medicare UPIN
PA084492Medicare PIN