Provider Demographics
NPI:1558393850
Name:VENIGALLA, MADHAVI (MD)
Entity Type:Individual
Prefix:
First Name:MADHAVI
Middle Name:
Last Name:VENIGALLA
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:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:1970 GOLF ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-6908
Practice Address - Country:US
Practice Address - Phone:941-957-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99505207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278871300Medicaid
203624OtherTUFTS HEALTH PLAN
FLDA5786OtherRAILROAD MEDICARE GROUP NUMBER
154658OtherHARVARD PILGRAM HLTH CARE
2018225OtherMEDICAID WELFARE
67085OtherFALLON COMM HEALTH PLAN
J26625OtherBLUE SHIELD HMO BLUE
MAA35942Medicare ID - Type Unspecified
FLAG244ZMedicare PIN
042472266OtherTRICARE
MA2018225Medicaid
A35942Medicare ID - Type UnspecifiedB
4090956OtherCIGNA HEALTH PLAN
042472266OtherPRIVATE HEALTHCARE SYSTEM
042472266OtherCHAMPUS
J26625OtherBLUE CARE ELECT
H92676Medicare UPIN
042472266OtherONE HEALTH PLAN
FL262945300Medicaid