Provider Demographics
NPI:1427068915
Name:SAMBASIVAN, VENKATARAMAN (MD, FACC)
Entity type:Individual
Prefix:
First Name:VENKATARAMAN
Middle Name:
Last Name:SAMBASIVAN
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N 14TH AVE STE 295
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-4195
Mailing Address - Country:US
Mailing Address - Phone:509-547-2413
Mailing Address - Fax:
Practice Address - Street 1:1200 N 14TH AVE STE 295
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4195
Practice Address - Country:US
Practice Address - Phone:509-547-2413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030872207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7051089Medicaid
WAE15050Medicare UPIN
WA7051089Medicaid