Provider Demographics
NPI:1548235674
Name:PASUPULETI, RAMARAO VENKATA (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMARAO
Middle Name:VENKATA
Last Name:PASUPULETI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 HIGH STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1745
Mailing Address - Country:US
Mailing Address - Phone:270-282-7116
Mailing Address - Fax:270-282-7121
Practice Address - Street 1:440 HIGH ST
Practice Address - Street 2:STE B
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1745
Practice Address - Country:US
Practice Address - Phone:270-282-7116
Practice Address - Fax:270-282-7121
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45502208VP0014X
KY37636208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64059298Medicaid
KY64059298Medicaid
CA4891Medicare PIN
KY0120902Medicare PIN
TN103I720154Medicare PIN