Doctor Name: | VENU MADHAV KONALA |
NPI Number: | 1164752952 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | BP10043399 |
Business Practice Address: | 122 Saint Christopher Dr Ashland, KY - 411017016 |
Business Phone Number: | 6068360202 |
Business Fax Number: | |
Mailing Address: | 122 Saint Christopher Dr, ASHLAND |
State: | KY |
Postal Code: | 411017016 |
Phone Number: | 6068360202 |
Fax Number: | |
NPI Enumeration Date: | 12/30/2009 |
NPI Last Update Date: | 06/24/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | BP10043399 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TX |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |