Provider Demographics
NPI:1770848640
Name:GANIPISETTI, VENU MADHAV (MD)
Entity Type:Individual
Prefix:
First Name:VENU
Middle Name:MADHAV
Last Name:GANIPISETTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:280 CHESTNUT STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:413-794-1629
Practice Address - Street 1:759 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1619
Practice Address - Country:US
Practice Address - Phone:413-794-6297
Practice Address - Fax:413-794-1767
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2018-0147207R00000X
IL125061149207R00000X
OH35.125961207R00000X
MA1014272207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine