Provider Demographics
NPI:1477828515
Name:BELLAMKONDA-ATHMARAM, VEDAVATHI RAMESH
Entity Type:Individual
Prefix:
First Name:VEDAVATHI
Middle Name:RAMESH
Last Name:BELLAMKONDA-ATHMARAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 CAMPUS DR
Mailing Address - Street 2:#350
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-2649
Mailing Address - Country:US
Mailing Address - Phone:763-520-1200
Mailing Address - Fax:612-874-2908
Practice Address - Street 1:2855 CAMPUS DR
Practice Address - Street 2:#350
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2649
Practice Address - Country:US
Practice Address - Phone:763-520-1200
Practice Address - Fax:612-874-2908
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN58892208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics