Provider Demographics
NPI:1376552323
Name:VRD RADIATION ONCOLOGY, PC
Entity Type:Organization
Organization Name:VRD RADIATION ONCOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VENKATA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DEVINENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-344-6090
Mailing Address - Street 1:2260 BARNBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-3130
Mailing Address - Country:US
Mailing Address - Phone:314-344-6090
Mailing Address - Fax:314-344-6093
Practice Address - Street 1:12303 DE PAUL DR
Practice Address - Street 2:DEPT. OF RADIATION ONCOLOGY
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2512
Practice Address - Country:US
Practice Address - Phone:314-344-6090
Practice Address - Fax:314-344-6093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODD4121Medicare ID - Type UnspecifiedRAILROAD