Provider Demographics
NPI:1902881568
Name:POLAVARAPU, VENKATA RATNAM (MD)
Entity type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:RATNAM
Last Name:POLAVARAPU
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 1:8710 E CANYON CT
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-4231
Mailing Address - Country:US
Mailing Address - Phone:254-472-4720
Mailing Address - Fax:
Practice Address - Street 1:1901 VETERANS MEMORIAL DR.
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504
Practice Address - Country:US
Practice Address - Phone:254-421-8196
Practice Address - Fax:254-778-4546
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH11812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114136802Medicaid
TXE20043Medicare UPIN
TXB63RMedicare ID - Type Unspecified