Provider Demographics
NPI:1588862478
Name:KASTURI, VELLORE G (MD)
Entity type:Individual
Prefix:DR
First Name:VELLORE
Middle Name:G
Last Name:KASTURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 E DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1431
Mailing Address - Country:US
Mailing Address - Phone:559-443-2682
Mailing Address - Fax:559-443-2681
Practice Address - Street 1:1418 E MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4836
Practice Address - Country:US
Practice Address - Phone:805-928-3678
Practice Address - Fax:805-928-6408
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA146393207SG0201X, 207V00000X
WV23055207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00733865OtherRR MEDICARE
WV3810012396Medicaid
WVP00733865OtherRR MEDICARE
WV3810012396Medicaid
WV2030584Medicare PIN
WVKA4233881Medicare PIN
WV2030582Medicare PIN
WV2030586Medicare PIN
WV2030588Medicare PIN
WV2030589Medicare PIN
WV2030583Medicare PIN
WV5119491Medicare PIN
WV2030581Medicare PIN
WV2030587Medicare PIN