Healthcare Provider Details

I. General information

NPI: 1013104470
Provider Name (Legal Business Name): RADHA VENKATRAMANAN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 BURLEY AVE SUITE A
HOPKINSVILLE KY
42240-8725
US

IV. Provider business mailing address

210 A BURLEY AVENUE
HOPKINSVILLE KY
42240
US

V. Phone/Fax

Practice location:
  • Phone: 270-889-0282
  • Fax: 270-887-8340
Mailing address:
  • Phone: 270-889-0282
  • Fax: 270-887-8340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number39289
License Number StateKY

VIII. Authorized Official

Name: DR. RADHA VENKATRAMANAN
Title or Position: MD/ PRESIDENT
Credential: MD
Phone: 270-889-0282