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General NPI Number Information
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NPI Number | 1982664348
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Entity Type | Organization
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Legal Business Name | DURAIRAJ VENKATASAMY MD PA
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 11/24/2010
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Provider Practice Location Address
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Address Line | 9633 W BROWARD BLVD SUITE 5
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City | PLANTATION
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State | FL
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Zip | 33324-2332
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Country | US
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Telephone | 954-474-4500
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Fax | 954-474-4559
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Provider Business Mailing Address
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Address Line | 9633 W BROWARD BLVD SUITE 5
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City | PLANTATION
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State | FL
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Zip | 33324-2332
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Country | US
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Telephone | 954-474-4500
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Fax | 954-474-4559
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DURAIRAJ VENKATASAMY
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Credential | M.D
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Telephone | 954-474-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME80895
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License Number State | FL
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