Healthcare Provider Details

I. General information

NPI: 1164751129
Provider Name (Legal Business Name): PRAMOD KUMAR VERMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 12/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 - 66 STREET
EDMONTON ALBERTA
T6K4C1
CA

IV. Provider business mailing address

2911 - 66 STREET
EDMONTON ALBERTA
T6K4C1
CA

V. Phone/Fax

Practice location:
  • Phone: 780-450-2400
  • Fax: 780-450-6471
Mailing address:
  • Phone: 780-450-2400
  • Fax: 780-450-6471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35.068294
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: