Provider Demographics
NPI:1477895035
Name:VENKATARAMAN, PUSHPALATHA TIRUMALE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:PUSHPALATHA
Middle Name:TIRUMALE
Last Name:VENKATARAMAN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9220 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6412
Mailing Address - Country:US
Mailing Address - Phone:440-354-9924
Mailing Address - Fax:877-242-9583
Practice Address - Street 1:801 E WASHINGTON ST
Practice Address - Street 2:SUITE 150
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3335
Practice Address - Country:US
Practice Address - Phone:330-722-1069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003757363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant