Provider Demographics
NPI:1184958464
Name:VENKATRAM NETHALA MD PC
Entity type:Organization
Organization Name:VENKATRAM NETHALA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VENKATRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NETHALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-527-7116
Mailing Address - Street 1:PO BOX 7299
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03247-7299
Mailing Address - Country:US
Mailing Address - Phone:603-527-7116
Mailing Address - Fax:603-737-6762
Practice Address - Street 1:85 SPRING ST
Practice Address - Street 2:SUIT # 3B
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3113
Practice Address - Country:US
Practice Address - Phone:603-527-7116
Practice Address - Fax:603-737-6762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-20
Last Update Date:2009-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8994207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty