Basic Information
| Provider Information | |||||||||
| NPI: | 1619263852 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VONTELA | ||||||||
| FirstName: | NAMRATHA | ||||||||
| MiddleName: | REDDY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1915 WHITE AVE | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379162300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8653311720 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 NEW YORK AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | OAK RIDGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8658355400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2011 | ||||||||
| LastUpdateDate: | 08/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 56301 | TN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 25049 | MS | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | Q033178 | 05 | TN | MEDICAID |