Provider Demographics
NPI:1487600979
Name:MOLAGAVALLI, VEENA (MD)
Entity type:Individual
Prefix:
First Name:VEENA
Middle Name:
Last Name:MOLAGAVALLI
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 1:362 N BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1148
Mailing Address - Country:US
Mailing Address - Phone:508-350-2350
Mailing Address - Fax:508-350-2318
Practice Address - Street 1:1 COMPASS WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1465
Practice Address - Country:US
Practice Address - Phone:508-350-2300
Practice Address - Fax:508-350-2310
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMX7805OtherMEDICARE PTAN #
MA219229OtherTAHP
MA2020289Medicaid
MA6000556OtherHPHC
MAJ26823OtherBC/BS
MAA36184Medicare PIN
MAMX7805OtherMEDICARE PTAN #