Provider Demographics
NPI:1982651014
Name:VASIREDDY, VENUGOPAL KIRAN (MD)
Entity Type:Individual
Prefix:
First Name:VENUGOPAL
Middle Name:KIRAN
Last Name:VASIREDDY
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 1:1955 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4712
Mailing Address - Country:US
Mailing Address - Phone:434-799-2055
Mailing Address - Fax:434-799-2044
Practice Address - Street 1:1955 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4712
Practice Address - Country:US
Practice Address - Phone:434-799-2055
Practice Address - Fax:434-799-2044
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056050207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005807328Medicaid
NC790583RMedicaid
VA282710OtherANTHEM
VA005807328Medicaid
NC790583RMedicaid