Provider Demographics
NPI:1871779124
Name:PRAMOD B. WASUDEV, M.D., PLLC
Entity type:Organization
Organization Name:PRAMOD B. WASUDEV, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAMOD
Authorized Official - Middle Name:B
Authorized Official - Last Name:WASUDEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-865-0700
Mailing Address - Street 1:PO BOX 22329
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37202-2329
Mailing Address - Country:US
Mailing Address - Phone:615-865-0700
Mailing Address - Fax:615-865-0701
Practice Address - Street 1:3443 DICKERSON PIKE
Practice Address - Street 2:SUITE 600
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2525
Practice Address - Country:US
Practice Address - Phone:615-865-0700
Practice Address - Fax:615-865-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11442208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TND32061Medicare UPIN