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General NPI Number Information
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NPI Number | 1376552323
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Entity Type | Organization
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Legal Business Name | VRD RADIATION ONCOLOGY, PC
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12303 DE PAUL DR DEPT. OF RADIATION ONCOLOGY
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City | BRIDGETON
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State | MO
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Zip | 63044-2512
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Country | US
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Telephone | 314-344-6090
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Fax | 314-344-6093
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Provider Business Mailing Address
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Address Line | 2260 BARNBRIDGE RD
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City | SAINT LOUIS
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State | MO
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Zip | 63131-3130
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Country | US
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Telephone | 314-344-6090
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Fax | 314-344-6093
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VENKATA R DEVINENI
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Credential | MD
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Telephone | 314-344-6090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State | MO
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