Provider Demographics
NPI:1659368645
Name:NANDIGAM, VEERENDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:VEERENDRA
Middle Name:
Last Name:NANDIGAM
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 1:30 RIDGECREEK TRL
Mailing Address - Street 2:
Mailing Address - City:MORELAND HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-2379
Mailing Address - Country:US
Mailing Address - Phone:440-498-2123
Mailing Address - Fax:
Practice Address - Street 1:4901 TURNEY RD
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2546
Practice Address - Country:US
Practice Address - Phone:216-641-7173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-3678208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0461941Medicaid
OHC02086Medicare UPIN
OH0461941Medicaid