Provider Demographics
NPI:1548233778
Name:VELLAYAN, PERIYAKARUPPAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PERIYAKARUPPAN
Middle Name:
Last Name:VELLAYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 HOSPITAL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOUTH WILLIAMSON
Mailing Address - State:KY
Mailing Address - Zip Code:41503-4095
Mailing Address - Country:US
Mailing Address - Phone:606-237-1000
Mailing Address - Fax:606-237-1001
Practice Address - Street 1:306 HOSPITAL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503-4095
Practice Address - Country:US
Practice Address - Phone:606-237-1000
Practice Address - Fax:606-237-1001
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20552207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64205529Medicaid
KY0446Medicare PIN
KY64205529Medicaid