Basic Information
| Provider Information | |||||||||
| NPI: | 1013104470 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADHA VENKATRAMANAN, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 A BURLEY AVENUE | ||||||||
| Address2: | |||||||||
| City: | HOPKINSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708890282 | ||||||||
| FaxNumber: | 2708878340 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 BURLEY AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | HOPKINSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422408725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708890282 | ||||||||
| FaxNumber: | 2708878340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2007 | ||||||||
| LastUpdateDate: | 10/01/2007 | ||||||||
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| AuthorizedOfficialLastName: | VENKATRAMANAN | ||||||||
| AuthorizedOfficialFirstName: | RADHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD/ PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2708890282 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 305R00000X | 39289 | KY | Y | Managed Care Organizations | Preferred Provider Organization |
No ID Information.