Provider Demographics
NPI:1033284062
Name:VEMUGANTI, VENKATESHWAR RAO (MD)
Entity Type:Individual
Prefix:DR
First Name:VENKATESHWAR
Middle Name:RAO
Last Name:VEMUGANTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 GUY PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010
Mailing Address - Country:US
Mailing Address - Phone:518-841-7354
Mailing Address - Fax:518-841-7344
Practice Address - Street 1:427 GUY PARK AVENUE
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010
Practice Address - Country:US
Practice Address - Phone:518-841-7354
Practice Address - Fax:518-841-7344
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18681712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01347855Medicaid
NY01347855Medicaid
NYE73100Medicare ID - Type Unspecified