Provider Demographics
NPI:1578658563
Name:BATHINI, VENU GOPAL (MD)
Entity Type:Individual
Prefix:
First Name:VENU
Middle Name:GOPAL
Last Name:BATHINI
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 1:171 MAIN ST STE 203B
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1187
Mailing Address - Country:US
Mailing Address - Phone:508-881-3029
Mailing Address - Fax:508-881-1752
Practice Address - Street 1:571 UNION AVE STE 202
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-5829
Practice Address - Country:US
Practice Address - Phone:508-665-6261
Practice Address - Fax:508-665-4175
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208195207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110033110AMedicaid
MA2000300Medicaid
MAA3505001Medicare PIN