Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | MD-016309-E | PA |
NPI | 1003925694 |
---|---|
Provider Name | Gopalan Vasudevan |
First Address | Greensburg, PA 15601-2768 |
Second Address | Greensburg, PA 15601-2768 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0956533 | (05) | PA |
B36969 | (02) | PA |