Provider Demographics
NPI:1942263082
Name:SOLA, VENKATSWARA (MD)
Entity Type:Individual
Prefix:DR
First Name:VENKATSWARA
Middle Name:
Last Name:SOLA
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:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:KY
Mailing Address - Zip Code:41649-0910
Mailing Address - Country:US
Mailing Address - Phone:606-285-6400
Mailing Address - Fax:606-285-6629
Practice Address - Street 1:11203 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:KY
Practice Address - Zip Code:41649-7999
Practice Address - Country:US
Practice Address - Phone:606-285-6400
Practice Address - Fax:606-285-6629
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64207194Medicaid
KY3331037Medicare PIN
KYC74081Medicare UPIN
KY64207194Medicaid
KY8577Medicare PIN
KY300127072Medicare PIN
KY5490Medicare PIN