Provider Demographics
NPI:1346484318
Name:VENKATESAN, NAREN NATRAJ (MD)
Entity Type:Individual
Prefix:
First Name:NAREN
Middle Name:NATRAJ
Last Name:VENKATESAN
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 1:3600 GASTON AVE STE 502
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1805
Mailing Address - Country:US
Mailing Address - Phone:469-800-7700
Mailing Address - Fax:469-800-7710
Practice Address - Street 1:3600 GASTON AVE STE 502
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1805
Practice Address - Country:US
Practice Address - Phone:469-800-7700
Practice Address - Fax:469-800-7710
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA131477207YX0905X
TXQ5595207YX0905X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX349961801Medicaid
TX8FK539OtherBCBS
TX433416YL1ZMedicare PIN