1720234735 NPI number — DR. VENMATHI INDRAMOHAN M.D

Table of content: DR. VENMATHI INDRAMOHAN M.D (NPI 1720234735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720234735 NPI number — DR. VENMATHI INDRAMOHAN M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
INDRAMOHAN
Provider First Name:
VENMATHI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720234735
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
715 DUNCAN AVE
Provider Second Line Business Mailing Address:
APT # 818
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15237-5887
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-775-1652
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 ONEIDA VALLEY RD
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
BUTLER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16001-2239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-620-6761
Provider Business Practice Location Address Fax Number:
724-282-3043
Provider Enumeration Date:
08/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  MD456370 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PENDING , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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