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General NPI Number Information
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NPI Number | 1427248962
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Entity Type | Individual
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Provider Name | VENKATARAMAN MUNUSAMY M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/31/2007
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Last Update Date | 08/10/2010
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Provider Practice Location Address
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Address Line | 200 SOMERSET ST
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City | MILLINOCKET
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State | ME
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Zip | 04462-1258
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Country | US
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Telephone | 207-723-5161
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Fax | 207-723-3040
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Provider Business Mailing Address
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Address Line | 200 SOMERSET ST
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City | MILLINOCKET
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State | ME
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Zip | 04462-1258
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Country | US
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Telephone | 207-723-5161
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Fax | 207-723-3040
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 018538
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License Number State | ME
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