Provider Demographics
NPI:1689818478
Name:A M VEDHA, MD PC
Entity Type:Organization
Organization Name:A M VEDHA, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARUNACHALAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:VEDHANAYAKAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-325-0461
Mailing Address - Street 1:1761 PARK AVE., SOUTHWEST
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-1626
Mailing Address - Country:US
Mailing Address - Phone:276-325-0461
Mailing Address - Fax:276-325-0469
Practice Address - Street 1:1761 PARK AVE., SOUTHWEST
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1626
Practice Address - Country:US
Practice Address - Phone:276-325-0461
Practice Address - Fax:276-325-0469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-24
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101023719261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA064175OtherANTHEM BLUE CROSS BLUE SHIELD
VA006744435Medicaid
VA006744435Medicaid