Provider Demographics
NPI:1467747733
Name:DASARI, VENKATA RAMANI (MD)
Entity Type:Individual
Prefix:
First Name:VENKATA
Middle Name:RAMANI
Last Name:DASARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 MONTCALM ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-1321
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:42 MONTCALM ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-1398
Practice Address - Country:US
Practice Address - Phone:315-343-2590
Practice Address - Fax:315-343-4197
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD458286207V00000X
MI4301093607207V00000X
NY262048-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3370270Medicaid
9927699OtherAETNA
12249030OtherCAQH
J400050945OtherMEDICARE
2173315OtherGROUP HEALTH INS
9056830OtherMVP HEALTH PLAN