MEDICARE: DR. VENKATA SIVA RAMAKRISHNA DANDAMUDI M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	246243	MA

General Provider Information

NPI Number	:	1184873762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VENKATA SIVA RAMAKRISHNA DANDAMUDI M.D

Provider Business Mailing Address
First Line	:	PO BOX 976
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93302-0976
Country	:	US
Telephone Number	:	617-636-5848
Fax Number	:

Provider Business Practice Location Address
First Line	:	3838 SAN DIMAS ST STE A140
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93301-1151
Country	:	US
Telephone Number	:	661-632-7126
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2008
Last Update Date	:	02/25/2019

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