Provider Demographics
NPI:1720234735
Name:INDRAMOHAN, VENMATHI (MD)
Entity Type:Individual
Prefix:DR
First Name:VENMATHI
Middle Name:
Last Name:INDRAMOHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 DUNCAN AVE
Mailing Address - Street 2:APT # 818
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5887
Mailing Address - Country:US
Mailing Address - Phone:310-775-1652
Mailing Address - Fax:
Practice Address - Street 1:127 ONEIDA VALLEY RD
Practice Address - Street 2:SUITE 400
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-2239
Practice Address - Country:US
Practice Address - Phone:866-620-6761
Practice Address - Fax:724-282-3043
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-09
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD456370207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPENDINGMedicaid
PAPENDINGMedicare PIN