Provider Demographics
NPI:1386128601
Name:GURRAM, VENKATESWARA RAO (MD)
Entity type:Individual
Prefix:
First Name:VENKATESWARA RAO
Middle Name:
Last Name:GURRAM
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 1:5075 WINSTER DR APT 202
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-2988
Mailing Address - Country:US
Mailing Address - Phone:336-734-3636
Mailing Address - Fax:
Practice Address - Street 1:5075 WINSTER DR APT 202
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-2988
Practice Address - Country:US
Practice Address - Phone:336-734-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2018-02003208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery