Provider Demographics
NPI:1275546038
Name:AKULA, VENKATA RAVI SANKARUN (MD)
Entity Type:Individual
Prefix:
First Name:VENKATA
Middle Name:RAVI SANKARUN
Last Name:AKULA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAVI
Other - Middle Name:
Other - Last Name:AKULA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:571 SAINT JOSEPHS BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:607-271-2099
Practice Address - Street 1:100 JOHN ROEMMELT DR
Practice Address - Street 2:SUITE 300
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8301
Practice Address - Country:US
Practice Address - Phone:607-795-2892
Practice Address - Fax:607-795-2816
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229731207R00000X, 207UN0901X, 207RC0000X
PAMD430566207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02462173Medicaid
PA100860936Medicaid
NY02462173Medicaid
NYP00076630OtherRAILROAD MEDICARE
PA100860936Medicaid