Provider Demographics
NPI:1609989284
Name:VENKATARAMAN, VIJAYA (MD)
Entity Type:Individual
Prefix:MRS
First Name:VIJAYA
Middle Name:
Last Name:VENKATARAMAN
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 1:618 PLEASANTVILLE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3325
Mailing Address - Country:US
Mailing Address - Phone:614-823-8500
Mailing Address - Fax:614-823-8501
Practice Address - Street 1:618 PLEASANTVILLE RD STE 103
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3325
Practice Address - Country:US
Practice Address - Phone:740-475-0502
Practice Address - Fax:740-689-8648
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35088209207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2686142Medicaid
OH4190282Medicare PIN
OH2686142Medicaid
OH4190283Medicare PIN
OHI59198Medicare UPIN