Basic Information
| Provider Information | |||||||||
| NPI: | 1164417879 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VENKATARAMAN | ||||||||
| FirstName: | AKILA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N ACADEMY AVE | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178224903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702716144 | ||||||||
| FaxNumber: | 5702716578 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 E MOUNTAIN BLVD | ||||||||
| Address2: | |||||||||
| City: | WILKES BARRE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187110027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708087300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2005 | ||||||||
| LastUpdateDate: | 02/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0008X | 001613 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | Neurodevelopmental Disabilities | 2084N0402X | MD471964 | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology |
ID Information
| ID | Type | State | Issuer | Description | 02350567 | 05 | NY | MEDICAID | 2603656 | 01 | NY | GHI | OTHER | 0100559 | 01 | NY | AMERICHOICE | OTHER | 2196604 04 | 01 | NY | UNITED HEALTHCARE | OTHER | 7863378 | 01 | NY | AETNA PPO | OTHER | P2640917 | 01 | NY | OXFORD HEALTH PLAN | OTHER | 127400101 | 01 | NY | HEALTH PLUS | OTHER | 001613-A15 | 01 | NY | HEALTH FIRST | OTHER | 501Z91 | 01 | NY | EMPIRE BCBS | OTHER | 1000028191 | 01 | NY | AFFINITY HEALTH | OTHER | 2969639 | 01 | NY | AETNA USHC HMO | OTHER | 4C2294 | 01 | NY | HEALTH NET | OTHER |