Basic Information
| Provider Information | |||||||||
| NPI: | 1659318442 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VATSAVAYI | ||||||||
| FirstName: | VENUGOPAL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | VATSAVAYI | ||||||||
| OtherFirstName: | VENU | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7373 PERKINS RD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708084373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252469790 | ||||||||
| FaxNumber: | 2252469160 | ||||||||
| Practice Location | |||||||||
| Address1: | 3401 NORTH BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708063743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2253812621 | ||||||||
| FaxNumber: | 2253877829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 01/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD.203338 | LA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 174400000X | 35936 | IA | N | Other Service Providers | Specialist | 2084P0802X | MD.203338 | LA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 4M443CT49 | 01 | LA | MEDICARE PTAN | OTHER | 1815357 | 05 | LA | MEDICAID |