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General NPI Number Information
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NPI Number | 1013104470
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Entity Type | Organization
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Legal Business Name | RADHA VENKATRAMANAN, PLLC
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 10/01/2007
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Provider Practice Location Address
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Address Line | 210 BURLEY AVE SUITE A
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-8725
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Country | US
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Telephone | 270-889-0282
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Fax | 270-887-8340
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Provider Business Mailing Address
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Address Line | 210 A BURLEY AVENUE
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City | HOPKINSVILLE
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State | KY
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Zip | 42240
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Country | US
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Telephone | 270-889-0282
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Fax | 270-887-8340
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Authorized Official
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Title or Position | MD/ PRESIDENT
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Name | DR. RADHA VENKATRAMANAN
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Credential | MD
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Telephone | 270-889-0282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 39289
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License Number State | KY
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