Provider Demographics
NPI:1013104470
Name:RADHA VENKATRAMANAN, PLLC
Entity Type:Organization
Organization Name:RADHA VENKATRAMANAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RADHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VENKATRAMANAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-889-0282
Mailing Address - Street 1:210 A BURLEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240
Mailing Address - Country:US
Mailing Address - Phone:270-889-0282
Mailing Address - Fax:270-887-8340
Practice Address - Street 1:210 BURLEY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-8725
Practice Address - Country:US
Practice Address - Phone:270-889-0282
Practice Address - Fax:270-887-8340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39289305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization