Provider Demographics
NPI:1245257815
Name:DURGAM, VEERENDRA V (MD)
Entity type:Individual
Prefix:
First Name:VEERENDRA
Middle Name:V
Last Name:DURGAM
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 1:45 CHIPPERFIELD CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-4568
Mailing Address - Country:US
Mailing Address - Phone:718-720-4130
Mailing Address - Fax:718-390-0485
Practice Address - Street 1:11 RALPH PL
Practice Address - Street 2:SUITE 217
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4419
Practice Address - Country:US
Practice Address - Phone:718-720-0224
Practice Address - Fax:718-390-0485
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186658207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01430139Medicaid
NY97H221Medicare ID - Type Unspecified
NY01430139Medicaid