Provider Demographics
NPI:1376506535
Name:VERMA, PREM SHANKAR (MD)
Entity Type:Individual
Prefix:MR
First Name:PREM
Middle Name:SHANKAR
Last Name:VERMA
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:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:KY
Mailing Address - Zip Code:41649-0910
Mailing Address - Country:US
Mailing Address - Phone:606-285-9426
Mailing Address - Fax:606-285-6619
Practice Address - Street 1:11176 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:KY
Practice Address - Zip Code:41649-7999
Practice Address - Country:US
Practice Address - Phone:606-285-9426
Practice Address - Fax:606-285-6619
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64212046Medicaid
5490Medicare ID - Type Unspecified
183421Medicare ID - Type Unspecified
8001Medicare ID - Type Unspecified
183440Medicare ID - Type Unspecified
5491Medicare ID - Type Unspecified
KY080090815Medicare PIN
KYC64464Medicare UPIN
183442Medicare ID - Type Unspecified
KY64212046Medicaid
183437Medicare ID - Type Unspecified
183438Medicare ID - Type Unspecified
183441Medicare ID - Type Unspecified
8577Medicare ID - Type Unspecified
6649Medicare ID - Type Unspecified