Provider Demographics
NPI:1952508699
Name:VADLAMUDI, VENU (MD)
Entity Type:Individual
Prefix:
First Name:VENU
Middle Name:
Last Name:VADLAMUDI
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 1:65 N FARMS RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3018
Mailing Address - Country:US
Mailing Address - Phone:703-888-8130
Mailing Address - Fax:
Practice Address - Street 1:100 NAVARRE PL STE 5500
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1172
Practice Address - Country:US
Practice Address - Phone:574-647-5200
Practice Address - Fax:574-647-5210
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYC20862085R0204X
TXU73692085R0204X
MI43010905942085R0204X
IN01087961A2085R0204X
CT727042085R0204X, 2085R0202X
VA01012558682085R0204X
TN589852085R0204X
MDD00939922085R0204X
IL036.1674872085R0204X
MA2953712085R0204X
AZ717732085R0204X
MS267162085R0204X
ARE-1123152085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology