Provider Demographics
NPI:1366591430
Name:PADMANABHAN, VELLORE T (MD)
Entity type:Individual
Prefix:DR
First Name:VELLORE
Middle Name:T
Last Name:PADMANABHAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 TOMS POINT LN
Mailing Address - Street 2:BLDG 3 APT 5H
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2101
Mailing Address - Country:US
Mailing Address - Phone:516-684-1220
Mailing Address - Fax:516-487-0576
Practice Address - Street 1:1 HOLLOW LN
Practice Address - Street 2:SUITE 312
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1215
Practice Address - Country:US
Practice Address - Phone:516-684-1220
Practice Address - Fax:516-487-0576
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY111481207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00734203Medicaid
NY00734203Medicaid
NY958721Medicare ID - Type Unspecified