Provider Demographics
NPI:1740246289
Name:VELAGA, VENKATESWARA (MD)
Entity type:Individual
Prefix:
First Name:VENKATESWARA
Middle Name:
Last Name:VELAGA
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:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42241-0548
Mailing Address - Country:US
Mailing Address - Phone:270-886-0251
Mailing Address - Fax:270-886-0252
Practice Address - Street 1:1600 CANTON ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1924
Practice Address - Country:US
Practice Address - Phone:270-886-0251
Practice Address - Fax:270-886-0252
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31612207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64316128Medicaid
E95444Medicare UPIN
KY64316128Medicaid