Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 12953 | MS |
Y | 2084N0402X | Child Neurologist | 12953 | MS |
NPI | 1174565469 |
---|---|
Provider Name | Mr. Vettaikorumakankav V Vedanarayanan |
First Address | Madison, MS 39110-6115 |
Second Address | Madison, MS 39110-2012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 23/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00019355 | (05) | MS |
155977 | (05) | AL |
1982156 | (05) | LA |
F12654 | (02) | MS |
P01234014 | RAILROAD MEDICARE PTAN (01) | MS |
PTAN P00462340 | RR MEDICARE (01) | MS |