Healthcare Provider Details

I. General information

NPI: 1942687470
Provider Name (Legal Business Name): VIVEKANANDA REDDY RACHAMALLU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 THOMAS MORE PKWY
CRESTVIEW HILLS KY
41017-3464
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-5901
  • Fax: 859-301-5940
Mailing address:
  • Phone: 859-301-5901
  • Fax: 859-287-3297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number53429
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: