Provider Demographics
NPI:1275749558
Name:BOMMANA, VENUGOPALA REDDY (MD)
Entity Type:Individual
Prefix:
First Name:VENUGOPALA
Middle Name:REDDY
Last Name:BOMMANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VENUGOPALA
Other - Middle Name:
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1 SEAGATE STE 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:567-585-0380
Mailing Address - Fax:567-585-0381
Practice Address - Street 1:6175 LEVIS COMMONS BLVD STE 104
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-7269
Practice Address - Country:US
Practice Address - Phone:567-585-0380
Practice Address - Fax:567-585-0381
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35089586207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine