Healthcare Provider Details

I. General information

NPI: 1871779124
Provider Name (Legal Business Name): PRAMOD B. WASUDEV, M.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3443 DICKERSON PIKE SUITE 600
NASHVILLE TN
37207-2525
US

IV. Provider business mailing address

PO BOX 22329
NASHVILLE TN
37202-2329
US

V. Phone/Fax

Practice location:
  • Phone: 615-865-0700
  • Fax: 615-865-0701
Mailing address:
  • Phone: 615-865-0700
  • Fax: 615-865-0701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number11442
License Number StateTN

VIII. Authorized Official

Name: DR. PRAMOD B. WASUDEV
Title or Position: OWNER
Credential: M.D.
Phone: 615-865-0700