Provider Demographics
NPI:1790870814
Name:VENKATARAMANA, KALIYUR G (MD)
Entity Type:Individual
Prefix:DR
First Name:KALIYUR
Middle Name:G
Last Name:VENKATARAMANA
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 1:122 FULTON ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-2717
Mailing Address - Country:US
Mailing Address - Phone:212-227-3670
Mailing Address - Fax:212-227-3693
Practice Address - Street 1:122 FULTON ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-2717
Practice Address - Country:US
Practice Address - Phone:212-227-3670
Practice Address - Fax:212-227-3693
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166883207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY75D381Medicare ID - Type Unspecified
NYA64139Medicare UPIN