Provider Demographics
NPI:1417974247
Name:PEDDI, VENKAT RAM (MD)
Entity Type:Individual
Prefix:
First Name:VENKAT
Middle Name:RAM
Last Name:PEDDI
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 254947
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-4947
Mailing Address - Country:US
Mailing Address - Phone:916-854-6975
Mailing Address - Fax:916-854-6844
Practice Address - Street 1:2340 CLAY ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1932
Practice Address - Country:US
Practice Address - Phone:415-600-1063
Practice Address - Fax:415-600-1065
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51237207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACG873ZOtherMEDICARE PIN (LOCALITY 9)
CAP00814837OtherMEDICARE RAILROAD
CACG873WOtherMEDICARE PIN (LOCALITY 99 SOUTHERN CA)
CACG873XMedicare PIN