Provider Demographics
NPI:1285690008
Name:JUPUDY, VENKATA RATNAM (MD)
Entity Type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:RATNAM
Last Name:JUPUDY
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 1:12845 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14004-1223
Mailing Address - Country:US
Mailing Address - Phone:716-937-3255
Mailing Address - Fax:716-204-7481
Practice Address - Street 1:12845 BROADWAY
Practice Address - Street 2:
Practice Address - City:ALDEN
Practice Address - State:NY
Practice Address - Zip Code:14004-1223
Practice Address - Country:US
Practice Address - Phone:716-937-3255
Practice Address - Fax:716-204-7481
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002046207R00000X
NY259595207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI01572Medicare UPIN
NYRA2417Medicare ID - Type Unspecified