Provider Demographics
NPI:1366494536
Name:NADELLA, VENKATESWARA RAO (MD)
Entity Type:Individual
Prefix:
First Name:VENKATESWARA
Middle Name:RAO
Last Name:NADELLA
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 1:6 NORTH CENTER ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701
Mailing Address - Country:US
Mailing Address - Phone:814-368-7000
Mailing Address - Fax:814-362-6243
Practice Address - Street 1:6 NORTH CENTER STREET
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701
Practice Address - Country:US
Practice Address - Phone:814-368-7000
Practice Address - Fax:814-362-6243
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037767L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000771889Medicaid
PA000771889Medicaid
NYDD1307Medicare PIN
DD1307Medicare PIN
PA006371D9SMedicare ID - Type Unspecified