Provider Demographics
NPI:1073580593
Name:MUTHUSAMY, VENKATARAMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:VENKATARAMAN
Middle Name:
Last Name:MUTHUSAMY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:155 MUIR RD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4611
Mailing Address - Country:US
Mailing Address - Phone:925-372-2084
Mailing Address - Fax:
Practice Address - Street 1:155 MUIR RD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4611
Practice Address - Country:US
Practice Address - Phone:925-372-2084
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125627-1208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery