Provider Demographics
NPI:1528003191
Name:VENKATARAMANA, ANITA BALEPUR (MD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:BALEPUR
Last Name:VENKATARAMANA
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 1:1350 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3278
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1155 MILL ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1576
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:775-982-5496
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1522992084N0400X
WI8072084N0400X
MDD633552084N0400X
OK415682084N0400X
CODR.00595802084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1528003191Medicaid
FLN7802OtherFL HF MEDICARE
MD235588400Medicaid
FL281383100Medicaid
NDP00868056OtherRR MEDICARE
FL281383100Medicaid
FLAL368ZMedicare PIN