Provider Demographics
NPI:1275074460
Name:SATYAM, VENKATA RAVI (MD)
Entity Type:Individual
Prefix:
First Name:VENKATA
Middle Name:RAVI
Last Name:SATYAM
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 1:51 MONTVALE AVE
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-2417
Mailing Address - Country:US
Mailing Address - Phone:781-213-5200
Mailing Address - Fax:781-481-9016
Practice Address - Street 1:51 MONTVALE AVE
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-2417
Practice Address - Country:US
Practice Address - Phone:781-213-5200
Practice Address - Fax:781-481-9016
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA287652207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine