Provider Demographics
NPI:1265597033
Name:INFECTIOUS DISEASES PSC
Entity type:Organization
Organization Name:INFECTIOUS DISEASES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAILAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELIGANDLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-325-0011
Mailing Address - Street 1:2301 LEXINGTON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2873
Mailing Address - Country:US
Mailing Address - Phone:606-325-0011
Mailing Address - Fax:
Practice Address - Street 1:2301 LEXINGTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2873
Practice Address - Country:US
Practice Address - Phone:606-325-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40111207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2652053Medicaid
OH2652053Medicaid