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1578623278

NPI Code Detail

MEDICARE: VENU M. MADHIPATLA MD

MEDICARE: VENU M. MADHIPATLA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	65559	GA
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	065559	GA
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	65559	GA
4	208VP0014X	Interventional Pain Medicine Physician	65559	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578623278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VENU M. MADHIPATLA MD

Provider Business Mailing Address
First Line	:	455 PHILIP BLVD STE 140
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-8768
Country	:	US
Telephone Number	:	770-962-3642
Fax Number	:	770-962-3643

Provider Business Practice Location Address
First Line	:	455 PHILIP BLVD STE 140
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-8768
Country	:	US
Telephone Number	:	770-962-3642
Fax Number	:	770-962-3643

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	10/01/2024

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Directions to “ VENU M. MADHIPATLA MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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