Provider Demographics
NPI:1447381728
Name:NAGARADDI, VENKATESH NARAYAN (MBBS)
Entity Type:Individual
Prefix:
First Name:VENKATESH
Middle Name:NARAYAN
Last Name:NAGARADDI
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4716 RAVENDALE DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3835
Mailing Address - Country:US
Mailing Address - Phone:972-860-9024
Mailing Address - Fax:972-525-8845
Practice Address - Street 1:4716 RAVENDALE DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3835
Practice Address - Country:US
Practice Address - Phone:972-860-9024
Practice Address - Fax:972-525-8845
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN662902084N0400X, 2084N0600X
NMMD2019-09062084N0400X
TXM74612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMMD2019-0906OtherNEW MEXICO MEDICAL BOARD