=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871779124
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRAMOD B. WASUDEV, M.D., PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2008
-----------------------------------------------------
Last Update Date | 01/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3443 DICKERSON PIKE SUITE 600
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37207-2525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-865-0700
-----------------------------------------------------
Fax | 615-865-0701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 22329
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37202-2329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-865-0700
-----------------------------------------------------
Fax | 615-865-0701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. PRAMOD B. WASUDEV
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 615-865-0700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 11442
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------