Provider Demographics
NPI:1174604466
Name:VENKATAYAN, NATARAJAN (MD)
Entity type:Individual
Prefix:
First Name:NATARAJAN
Middle Name:
Last Name:VENKATAYAN
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 1:4302 EGREMONT PL
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-3212
Mailing Address - Country:US
Mailing Address - Phone:936-404-3309
Mailing Address - Fax:
Practice Address - Street 1:501 E COLORADO ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6025
Practice Address - Country:US
Practice Address - Phone:361-579-8300
Practice Address - Fax:361-579-8303
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4617207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A0023OtherBLUE CROSS
TX189776101Medicaid
TX189776101Medicaid
TX8J6798Medicare PIN
TXP00443345Medicare PIN