Provider Demographics
NPI:1710976733
Name:GADDAM, VENKATARAMA REDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:VENKATARAMA
Middle Name:REDDY
Last Name:GADDAM
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:DEPT L-3652
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-6453
Mailing Address - Country:US
Mailing Address - Phone:740-383-7980
Mailing Address - Fax:740-383-3040
Practice Address - Street 1:1050 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6416
Practice Address - Country:US
Practice Address - Phone:740-383-7980
Practice Address - Fax:740-383-3040
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-084203207RI0011X
OH35084203207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2486797Medicaid
I06453Medicare UPIN
OHH367083Medicare PIN
GA4132856Medicare PIN