Individual
DR. NAGAGOPAL VENNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15 PARKMAN ST, WAC 835, BOSTON, MA 02114-3117
(617) 726-5533
(617) 726-6991
Mailing address
PO BOX 9142, CHARLESTOWN, MA 02129-9142
(617) 726-7643
(617) 726-6991
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
41708
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2070057
—
MA
01
—
712756
TUFTS HEALTH PLAN
MA
01
—
M09965
BCBS MA
MA
Enumeration date
11/07/2005
Last updated
09/07/2012
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